Emory Transplant Center
Wk1-4Wk5-8Wk10Mon3Mon4Mon5Mon6Mon7Mon8Mon9Mon12>12 monthsVisits, Labs, and ReportsWeekly Visit w/ labsWk 1Wk 2Wk 6Wk 10HepatologyAnnualLabs onlyThree weeklyTwice weeklyWeeklyMonthlyUNOS ReportHospital DCAnnualAlloantibody ScreenAnnual for SLKInfection Prophylaxis/MonitoringCMV prophylaxisD+/R-: Valcyte 900 mg qdayAny R+; D-/R-: pre-emptive therapy with weekly CMV PCRCMV PCRevery 2 weeksAnnual CMV PCRAntifungal prophylaxisNystatin 500,000 units QID(if not on azole antifungal)PCP prophylaxisBactrim SS daily (alternatives: atovaquone, dapsone, inhaled pentamidine)BK virus(SLK only)Wk 4Wk 8*SeeBK ProtocolCardiovascular Risk ReductionGoals of careBMI ≤25 kg/m2BP ≤130/80 mmHgCholesterol <200 mg/dLAnnual ScreenLipid profileAnnualDiabetes ManagementHgb A1C (if only steroid)OphthalmologyIf blood glucose consistently >150 mg/dL, consult EndocrinologyQ3monannuallyVaccinations (starting 3 months post-transplant)InfluenzaAnnualPneumococcalEvery 5 yearsBone Disease ManagementBone density scan (DEXA)As indicatedDentalRoutine visitsQ6monannuallyCancer Screening and ProphylaxisGeneral ExamsExams by PCP; Breast (>40 yo); Cervical (>18 yo); Prostate (>40 yo)AnnualDermatologyAnnualSigmoidoscopy or colonoscopyColorectal screening: colonoscopy prior to or at 1 year post-transplant; if negative, FOBT in 5 yearsColorectal cancer screening: if negative, repeat colonoscopy 10 years after previous negative examPSC and UC: annual colonoscopy with surveillance biopsies; maintain breast, cervical, and/or prostate examsq5-10 yrsPatient Education MaterialsA Journey for Life and Pathway DocumentationProvide additional education materials at clinic visits as appropriate based on medical conditionsAssessmentsDietitianAnnualSocial WorkerAnnualPrednisone Taper0-1 month1-2 months2-3 months>3 monthsAIH20 mg10 mg5 mg5 mgOther indications20 mg10 mg5 mgnoneImmunosuppressant0-3 months3-6 months6-12 months>1 yearTacrolimus (Prograf)8-12 ng/ml6-8 ng/ml6-8 ng/ml3-5 ng/mlCyclosporine (Gengraf)150-180 ng/ml100-150 ng/ml75-125 ng/ml50-100 ng/mlMycophenolate mofetil (Cellcept)1000 mg BID1000 mg BID1000 mg BID1000 mg BID*Sirolimus (Rapamune)8-12 ng/ml6-12 ng/ml4-10 ng/ml3-8 ng/mlEverolimus (Zortress)8-12 ng/ml6-12 ng/ml4-10 ng/ml3-8 ng/ml*May consider decreasing or discontinuing mycophenolate after 1 year post-transplant on case-by-case basisMycophenolate Dosage AdjustmentIndication for Dose Reduction/Dosing Interval ChangeApproach to ReinstitutionDiarrhea refractory to treatmentUpon resolution of symptomsDyspepsia refractory to treatmentStepwise increase in 250 mg increments to 1000 mg BIDPregnancy (discontinue)WBC <3 (decrease by 50%)WBC <2 or ANC <500 (hold)Viral/fungal infectionMD discretionEmory Liver Transplant ProgramRev. 09.16.21 ................
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