Transplant: Immunosuppression

Prograf levels - Typically goal 5-7 once stable post-tx (>3 months). 7-10 if some concern for rejection or 4-6 if concern for infection or CNI toxicity. Check patient’s note.

Vaccines:

PPSV:

Figure 2A shows the incidence of pneumococcal disease in the normal population is around 10 cases per hundred thousand patient years. Figure 2E shows the incidence of invasive pneumococcal disease in solid organ transplants showing an incidence of 465 cases per 100,000 patient years, so nearly 50 times increase risk.

Pneumococcal meningitis or bacteremia can kill and certainly disable or cause extensive brain damage. In healthy patients the case fatality rate is between 1.5 and 14%, and it is up to 28.6% in solid organ transplants.

In 2018 a consortium of infectious diseases, transplantation, vaccinology, and immunology experts concluded that MMR and/or varicella vaccines may be safe to administer in kidney or liver transplant recipients who are clinically well, at least 1 year post-transplant and at least 2 months post-rejection episode, maintained on a low-intensity immunosuppression, and meet minimum immune criteria.

https://onlinelibrary.wiley.com/doi/10.1111/ctr.14577

https://pubmed.ncbi.nlm.nih.gov/31497926/