Chapter 33: Transplant & Immunosuppressant Drugs

Transplant & Immunosuppressant Drugs outlines the pathophysiology of the immune response to transplanted tissues and categorizes rejection into hyperacute, acute, and chronic phases, noting that the host's immune system remains the primary barrier to graft survival. The text details the strategic use of induction therapy to provide intense initial immunosuppression using agents like basiliximab, a monoclonal antibody that inhibits lymphocyte activation, while highlighting the risk of cytokine release syndrome. Maintenance therapy strategies are extensively covered, featuring calcineurin inhibitors (CNIs) such as cyclosporine and tacrolimus which inhibit T-lymphocyte proliferation but carry significant risks of nephrotoxicity, neurotoxicity, and QT prolongation. The discussion expands to costimulation blockers like belatacept, which requires Epstein-Barr virus seropositivity due to posttransplant lymphoproliferative disorder risks, and mammalian target of rapamycin (mTOR) inhibitors like sirolimus and everolimus, known for adverse effects such as hyperlipidemia and impaired wound healing. Additional drug classes reviewed include purine antimetabolites (azathioprine) and inosine monophosphate dehydrogenase inhibitors (mycophenolate mofetil), often used in combination with corticosteroids like prednisone to suppress inflammation and lymphocyte volume. Crucial nursing considerations are emphasized throughout, including the absolute contraindication of live vaccines for immunocompromised patients, the necessity of therapeutic drug monitoring to avoid toxicity, and the avoidance of metabolic interactions such as grapefruit juice with CNIs. The chapter concludes by applying the clinical judgment model to promote patient adherence, a vital factor in long-term graft survival, and details infection control measures such as neutropenic precautions and prophylaxis against opportunistic pathogens like Pneumocystis jiroveci pneumonia and cytomegalovirus.