Proliferation signal inhibitors (MTOR inhibitors) Inhibit T cell activation via a different pathway to Calcineurin inhibitors Not commonly used immediately post transplant due to poor wound healing Sirolimus 3 mg/m2 stat then Poor wound 1mg/m2 daily oral, healing Oral ulcerations Dyslipidaemia Oedema Lung toxicity Pleural effusions Cytopaenias Nephrotoxicity Everolimus Dependent on Heart: Poor wound trough Blood levels No cyclosporin healing No Tacro: Usual Adult dose Acne 1.5mg-3mg BD Mouth ulcers With cyclosporin Pleural effusions With Tacro: Levels after 4 days of dose ∆ Corticosteroids Heart: starting None Weight gain Methylprednisolone 10mg/kg/dose BD Hypertension Liver:: starting Hyperlipidaemia 2.5mg/kg/dose (max Osteopenia 25mg) IV 6 hourly Hyperglycaemia tapering to Poor healing 1mg/kg/dose (max Salt/water 10mg) IV 12 hourly. retention Then: Prox. myopathy
Proliferation signal inhibitors (MTOR inhibitors) Inhibit T cell activation via a different pathway to Calcineurin inhibitors Not commonly used immediately post transplant due to poor wound healing Sirolimus 3 mg/m2 stat then 1mg/m2 daily oral, Poor wound healing Oral ulcerations Dyslipidaemia Oedema Lung toxicity Pleural effusions Cytopaenias Nephrotoxicity Everolimus Dependent on trough Blood levels Usual Adult dose 1.5mg-3mg BD Heart: No cyclosporin No Tacro: With cyclosporin With Tacro: Levels after 4 days of dose ∆ Poor wound healing Acne Mouth ulcers Pleural effusions Corticosteroids Methylprednisolone Heart: starting 10mg/kg/dose BD Liver:: starting 2.5mg/kg/dose (max 25mg) IV 6 hourly tapering to 1mg/kg/dose (max 10mg) IV 12 hourly. Then: None Weight gain Hypertension Hyperlipidaemia Osteopenia Hyperglycaemia Poor healing Salt/water retention Prox. myopathy
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