Immunosuppression
Calcineurin inhibitors (calcineurin produces cytokines in T-cells to trigger proliferation and differentiation)
- Cyclosporin (complexes with cyclophilin blocking calcineurin)
- Tacrolimus (complexes with FKBP‑12 blocking calcineurin)
Corticosteroids
- Betamethasone
- Cortisone
- Dexamethasone
- Hydrocortisone
- Methylprednisolone
- Prednisolone/prednisone
- Triamcinolone
Immunosuppressant antibodies
- Antithymocyte globulins (antibodies against T-Lymphocytes)
- Basiliximab (inhibits T-cell proliferation)
AntiTNFα (risk of lymphoma)
- Infliximab
- adlimumab (Humira)
mTOR inhibitors (mammalian target of rapamycin) (complexes with FKBP‑12 blocking mTOR kinase and thus B/Tcell proliferation)
- Everolimus (immunosuppressant)
- Sirolimus
Antimetabolite
- Azathioprine
Others
- Mycophenolate
NB: Screen for latent infection first, antiviral prophylaxis may be required
All:
TB
Hep B (can be reactivated)
Transplant recipients:
EBV
CMV
HSV
VZV
HIV
HepC.
Monitor during and for 12 month post immunosuppression for hepatitis
Live vaccines should not be used
Other vaccine responses are likely to be suboptimal
- Cyclosporin (complexes with cyclophilin blocking calcineurin)
- Tacrolimus (complexes with FKBP‑12 blocking calcineurin)
Corticosteroids
- Betamethasone
- Cortisone
- Dexamethasone
- Hydrocortisone
- Methylprednisolone
- Prednisolone/prednisone
- Triamcinolone
Immunosuppressant antibodies
- Antithymocyte globulins (antibodies against T-Lymphocytes)
- Basiliximab (inhibits T-cell proliferation)
AntiTNFα (risk of lymphoma)
- Infliximab
- adlimumab (Humira)
mTOR inhibitors (mammalian target of rapamycin) (complexes with FKBP‑12 blocking mTOR kinase and thus B/Tcell proliferation)
- Everolimus (immunosuppressant)
- Sirolimus
Antimetabolite
- Azathioprine
- Purine antimetabolite. Azathioprine > mercaptopurine > thioguanine nucleotides, which interfere with purine synthesis, impairing lymphocyte proliferation, cellular immunity and antibody responses
Others
- Mycophenolate
NB: Screen for latent infection first, antiviral prophylaxis may be required
All:
TB
Hep B (can be reactivated)
Transplant recipients:
EBV
CMV
HSV
VZV
HIV
HepC.
Monitor during and for 12 month post immunosuppression for hepatitis
Live vaccines should not be used
Other vaccine responses are likely to be suboptimal