immunosuppressive drugs basics and side effect

1. By
Dr. Salwa M. Elwasif, MD
Fellow of Internal Medicine and Nephrology
Urology and Nephrology Center
Mansoura University
Immunosuppressive therapy in
renal transplantation
12th December , 2020

2. Introduction
 Renal transplantation is the treatment of choice in
selected cases of renal failure.
 Maintenance immunosuppressive drugs is crucial for
graft survival.
 Patient adherence to immunosuppressive drugs is
one of predictor for long lasting graft.

3. compliance
adherence

4. Types of
immunosuppressive
drugs
Induction Maintenance

5. Groups of maintenance immunosuppressive
drugs
steroidsCNI
Antiprolefrative
mTORi

6. Immunosuppression:
Maintenance

7. mTORi: Current Use

8. Steroids

9. Transplantation October 2017;101: 2590–2598
Steroid Withdrawal:
What is the effect on long-term?

10. Tacrolimus
Pediatric Nephrology, Accepted: 10 January 2018

11. Tacrolimus Variability

12. CYP3A5
Transplantation 2008;85: 163–165 . Review

13. University Hospital Heidelberg
CNI and NFAT-RE
Monitoring

14. Q. What Drug is Behind These Signs?
American Journal of Transplantation November 2017; 17: 2782–2789

15. Cutaneous toxicity of immunosuppressive
drugs

17. Am J Kidney Dis. May 2017;69(5):e21-e22
Q. Graft Biopsy:
What is your diagnosis?

18. munosuppressive:
cyclosp
0- 75 ng/ml), everolimus (
ng/ml, and ste
Im orine (trough level
5 trough level 3-8
roid
Q
Am J Kidney Dis. August 2017;70(2):A13-A15.
What is your
diagnosis?

20. Patients with CV >44.2% and TTR <40% (high intrapatient
variability and low TTR) had a high risk of dnDSA (

21. Tacrolimus C/D
Fast metabolizers could be a
strategy to improve graft survival

22. Tacrolimus C/D
Kidney Blood Press Res. 2019 Sep 13:1-14

23. Late Intra-patient Tacrolimus Level
Variability
Am J Transplant. 2019 Oct;19(10):2805-2813.
6600 patients with a functioning
graft for
>3 years

24. Transplantation Proceedings, 51, 2615-2619 (October 2019)
Prograf vs Advagraf
Transplant International November 2019; 32: 1182–1193

26. MPA

27. J Am Med Inform Assoc2014;21:e93–e99.
Preemptive
Pharmacogenomics

28. TPMT
Nat Rev Drug Discov 2005; 4:639.

29.  Mycophenolic acid (MPA) drugs should be
avoided in women thinking of pregnancy.
However, their use for men who are willing for
fatherhood are absolute safe.
A. True
B. False
Q

30. Renal Transplant CPG:
Conception

31. Immunosuppression:
Impact on Male Reproduction

32. Transplantation July 2017;101: e214–e217
MMF and Fatherhood

33. Indian J Nephrol. 2017 May-Jun;27(3):215-217.
Q. What Drug is Behind These Findings?

34. Indian J Nephrol. 2017 May-Jun;27(3):215-217.
Q. What Drug is Behind These Findings?

35. Thank you