1. Immunosuppressant Medications Calcineurin Inhibitors (CNI) Prograf/Tacrolimus/Hecoria

1. Common Medications in Abdominal Transplantation Post-Transplant Complications Post-Transplant Care/Management • 1. Visit Frequency • Surgeon – within one week of discharge • RN visit 2-3x/week for first 2 weeks • Hepatologist – 1 month, 3 months, 6 months then annually and prn • If Liver kidney/then follow both liver and kidney schedules • Primary Care Provider - annually • Laboratory Frequency – see chart • Health Maintenance Schedule • Vaccinations • No live vaccines • Annual seasonal influenza • Pneumonia vaccine q5 years • Hepatitis A and B if not immune • Hepatitis B high-dose (40mg) day 0, 7, 28 • Colonoscopy –per ACS guidelines • Pap Smear/HPV testing –annually • Mammogram—per ACS guidelines • Annually (with risk assessment) • Lipids • Q6-12 months • f. Dermatology screening • i. Annually • 1. Immunosuppressant Medications • Calcineurin Inhibitors (CNI) • Prograf/Tacrolimus/Hecoria • Neoral/Cyclosporine/Gengraf • b. mTor Inhibitors • Rapamune/Sirolimus • Zortress/Everolimus • Prednisone • Anti-proliferative medications • Myfortic/Mycophenolic acid (enteric coated) • Cellcept/Mycophenolate mofetil • Imuran/Azathioprine • Infection Prophylaxis Medications • PCP Prophylaxis • Bactrim SS/SMTZ SS QD • After one year can be changed to TIW • OR • ii. Mepron/Atovaquone (sulfa allergy) – stopped after one year • CMV prophylaxis – Valcyte 900 mg po qd x 6 months (if D-/R-then acyclovir qd x 6mos); • if Liver/Kidney then 450 mg po qd x 6 mos • Anti-fungal—Nystatin 500,000 units po qid x 3 mos • Common Calcineurin Inhibitor Drug Interactions* • Azole anti-fungals • Protease inhibitors • Grapefruit • Erythromycin/Macrolides • Diltiazem/Verapamil • Statins will require lower starting dose • CYP450 medications can alter CNI levels • * Not an exhaustive list • 1. Surgical Complications • Vascular • i. Stenosis –can be managed by interventional radiology or surgical intervention if necessary—should be done at transplant center preferably • ii. Hepatic Artery • a. US to assess for hepatic artery thrombosis day around 12 • Wound • i. Dehiscence and infections most common in the first three months—more prevalent in diabetics, obese population. • Biliary Complications • a. Stenosis – ERCP usually indicated • b. Ischemic cholangiopathy • i. ERCP for management and may need to be relisted • Medical Complications • Hypertension • Hyperlipidemia • Chronic kidney disease • Malignancies • Anemia • Leukopenia • Non-Alcoholic Steatohepatitis • Infectious Complications • Pneumocystis pneumonia • Cytomegalovirus • Fungal • BK virus • Varicella zoster • Urinary tract infections Reference: Lucey, M. R., Terrault, N., Ojo, L., Hay, J. E., Neuberger, J., Blumberg, E. and Teperman, L. W. (2013), 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, 19: 3–26. doi: 10.1002/lt.23566

2. Liver Transplant Standard of Care (SOC) Labs *only those child-bearing females (ages up to 60) on Myfortic, Cellcept, mycophenolate mofetil or mycophenolic acid ^for patients who are HBsAg+ or HBcAb+ or those who received a donor HBcAb + organ - If patient is a combined liver and kidney patient then please follow both this protocol and the post kidney protocol

3. The Timeline of Post-Transplant Infections Modified from 1-3 Donor- Derived NOSOCOMIAL TECHNICAL DONOR/RECIPIENT Activation of Latent Infections, Relapsed, Residual, Opportunistic Infections COMMUNITY ACQUIRED TRANSPLANTATION DYNAMIC ASSESSMENT OF INFECTIOUS RISK Recipient- Derived < 4 WEEKS 1-6 MONTHS > 6 MONTHS Common Infections in Solid Organ Transplantation Recipients