levels levels levels levels Cyclosporine (Gengraf) 1000mg 1000mg 1000mg 1000mg MMF (Cellcept) BID BID BID BID* Sirolimus (Rapamune) or 1month levels Everolimus (Zortress) levels 6-12 10 levels 3-8 6 > 1 Prednisone days 1 month 2 months 3 months months year Non-Viral Hepatitis, 20mg Off at day HBV/Others, PSC, PBC QAM 10mg 5mg 90 off 20mg AIH QAM 10mg 5 mg 5mg 5mg 5mg *Consider decreasing or eliminating mycophenolate after 1 year post-transplant on a case by case basis. Immunosuppressive regimens will be individualized on a case by case basis based on creatinine, serum potassium, liver function profile, history of rejection or CMV status, and underlying disease process. References: Simone PD, Nevens F, DeCarlis L, et al. Everolimus with reduced tacrolimus improves renal function in de novo liver transplant recipients: a randomized controlled trial. AJT 2012; 12: 3008-3020. Fisher L, Klempnauer J, Beckebaum S, et al. A randomized, controlled study to assess the conversion from Calcineurin inhibitors to everolimus after liver transplantation PROTECT. – AJT 2012;12: 1855-1865. Masetti M, Montalti R, Rompianesi, et al. Early withdrawal of Calcineurin inhibitors and everolimus monotherapy in de novo liver transplant recipients preserves renal function. AJT 2010;10: 2252-2262. Neupogen® (filgrastim) [package insert]. Thousand Oaks, CA: Amgen Inc.; 2015. Related Policies/Procedures: Concomitant medications, Renal-sparing protocol Approved by: Liver Transplant Leadership Group __________________________________ Joseph Magliocca, MD Chair, Liver Transplant Leadership Group Director, Liver Transplant Program ____________________________________ Ram Subramanian, MD Medical Director, Liver Transplant Program
Cyclosporine (Gengraf) levels levels levels levels MMF (Cellcept) 1000mg BID 1000mg BID 1000mg BID 1000mg BID* Sirolimus (Rapamune) or Everolimus (Zortress) 1month levels 6-12 levels levels 3-8 Prednisone 10 days 1 month 2 months 3 months 6 months > 1 year Non-Viral Hepatitis, HBV/Others, PSC, PBC 20mg QAM 10mg 5mg Off at day 90 off AIH 20mg QAM 10mg 5 mg 5mg 5mg 5mg *Consider decreasing or eliminating mycophenolate after 1 year post-transplant on a case by case basis. Immunosuppressive regimens will be individualized on a case by case basis based on creatinine, serum potassium, liver function profile, history of rejection or CMV status, and underlying disease process. References: Simone PD, Nevens F, DeCarlis L, et al. Everolimus with reduced tacrolimus improves renal function in de novo liver transplant recipients: a randomized controlled trial. AJT 2012; 12: 3008-3020. Fisher L, Klempnauer J, Beckebaum S, et al. A randomized, controlled study to assess the conversion from Calcineurin inhibitors to everolimus after liver transplantation – PROTECT. AJT 2012;12: 1855-1865. Masetti M, Montalti R, Rompianesi, et al. Early withdrawal of Calcineurin inhibitors and everolimus monotherapy in de novo liver transplant recipients preserves renal function. AJT 2010;10: 2252-2262. Neupogen® (filgrastim) [package insert]. Thousand Oaks, CA: Amgen Inc.; 2015. Related Policies/Procedures: Concomitant medications, Renal-sparing protocol Approved by: Liver Transplant Leadership Group __________________________________ Joseph Magliocca, MD Chair, Liver Transplant Leadership Group Director, Liver Transplant Program ____________________________________ Ram Subramanian, MD Medical Director, Liver Transplant Program