Information
Example
Transplanted organ, indication, and date of transplant
Liver transplant for hepatitis C cirrhosis 3 years ago
Status of transplanted organ:
Current function
Transaminases, liver synthetic function (bilirubin, INR, albumin), creatinine
Last liver biopsy
Presence of recurrent disease in the transplanted organ
Hepatitis C viral load
Prior episodes of rejection and increased immunosuppression
One episode of rejection 2 years ago, treated with pulse steroids
Function of other organs that may be affected by immunosuppressive regimen or transplanted organ dysfunction
Mild chronic kidney disease from calcineurin inhibitor (tacrolimus)
Perioperative Management
Graft Function
Follow for signs of graft dysfunction, which may include examination and laboratory monitoring (e.g., creatinine for renal transplant)
Coordinate with transplant specialist when appropriate
Medication Management
Consider supplemental (“stress”) dose steroids when indicated (see Chap. 14).
Continue all usual immunosuppressant medications, including the morning of surgery.
If patient receives prophylactic medications against opportunistic infections, continue them.
If NPO postoperatively, convert antirejection medications to IV. Table 42.2 shows the general guidelines and recommendations for when to consult with a transplant pharmacist.
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