Abdominal Transplant Immunosuppression Management - Adult - Inpatient/ Ambulatory Consensus Care Practice Guideline Target Population: adult patients with history of an abdominal organ transplant who require immunosuppressive medications Full Guideline: Abdominal Transplant Immunosuppression Management - Adult - Inpatient/Ambulatory Guideline Overview • Objective: to provide recommendations for managing immunosuppressive medications in patients with a history of abdominal transplant (i.e. kidney, liver, pancreas) which will facilitate decision making for physicians, mid-level providers, pharmacists, and nursing staff • Drug information is organized by the organ transplanted and includes dosing, target blood levels, common drug interactions, necessary monitoring, and common adverse effects Drugs for maintenance immunosuppression ▪ Azathioprine ▪ Belatacept ▪ Cyclosporine ▪ Everolimus ▪ Mycophenolate ▪ Prednisone ▪ Sirolimus ▪ Tacrolimus Drugs for renal transplant induction, desensitization, and rejection ▪ Alemtuzumab ▪ Basiliximab ▪ Dexamethasone ▪ IVIG ▪ Rituximab ▪ Thymoglobulin Recommendations are based on long-standing clinical experience and are supported by very low quality evidence. Collateral Tools and Resources Order sets and smart sets • IP - Pancreas Transplant - Adult - Postoperative [2889] • IP - Renal Transplant Recipient - Adult - Postoperative [2895] • IP - Renal/Pancreas Transplant - Rejection - Adult - Medical Admission [766] • IP - Liver Transplant - Adult - Intensive Care Unit - Postoperative [2885] • IP - Renal and Pancreas Transplant - Adult - Postoperative [2927] • IP - Transplant - Immunosuppression - Antithymocyte Globulin (Rabbit) - Adult - Supplemental [771] References 1. Kidney Disease: Improving Global Outcomes Transplant Work G. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant. 2009;9 Suppl 3:S1-155. 2. Ekberg H, Tedesco-Silva H, Demirbas A, et al. Reduced exposure to calcineurin inhibitors in renal transplantation. N Engl J Med. 2007;357(25):2562-2575. 3. Hanaway MJ, Woodle ES, Mulgaonkar S, et al. Alemtuzumab induction in renal transplantation. N Engl J Med. 2011;364(20):1909-1919. 4. Lucey MR, Terrault N, Ojo L, et al. Long-term management of the successful adult liver transplant: 2012 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Liver Transpl. 2013;19(1):3-26. 5. Scott LJ, McKeage K, Keam SJ, Plosker GL. Tacrolimus: a further update of its use in the management of organ transplantation. Drugs. 2003;63(12):1247-1297. Copyright © 2021 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission Contact: CCKM@uwhealth.org Last Revised: 07/2021 Effective 6-17-2021. Contact CCKM@uwhealth.org for previous versions.