Liver Transplantation

Liver Transplantation at Baylor:
Disease-Specific Results and Long-Term Outcomes

Robert M. Goldstein

Table 3. Baylor University Medical Center Liver Transplantation Immunosuppressive Protocol

Standard Acute Oliguric Coma III & IV Hepatitis B,C Elderly
>/= 60 y/o
FK506/CYA FK506 po
0.15 mg/kg BID po (0.03 mg/kg BID IV)
Level:10-20		 No FK506 for up to 72 hrs to 96 hrs if UOP <50-100 cc/hr. If still oliguric begin OKT3. Begin FK when kidneys open up.

Stop AZA when FK level is therapeutic unless needed for renal sparing.		 OKT3, 5 mg QD for 5-7 days, when awake begin FK506. CYA
IV 1-1.5 mg/kg over 12 hrs continuous infusion; begin po CYA 1000 mg every 12 hrs while (down arrow) IV and adjust po dose.*
(blood level: 250-400)		 CYA
IV 1-1.5 mg/kg over 12 hrs continuous infusion; begin po CYA 1000 mg every 12 hrs while (down arrow) IV and adjust po dose.*
(blood level: 180-250)
AZA NONE 2 mg/kg** for 7 days (with LFTs <2000) 2 mg/kg** for 7 days (with LFTs <2000) 2 mg/kg** for 7 days (with LFTs <2000) NONE
PREDNISOLONE Preop:
50 mg Solu-Medrol IV
Intraop:
1 gm Solu-Cortef
Postop:
taper Solu-Medrol:
100 mg - day 1
80 mg - day 2
60 mg - day 3
40 mg - day 4
Prednisolone:
20 mg - day 5
15 mg - day 14
12.5 mg - day 21
10 mg - day 28
7.5 mg - day 60
5 mg - day 90
(D/C at day 360)		 Preop:
50 mg Solu-Medrol IV
Intraop:
1 gm Solu-Cortef
Postop:
taper Solu-Medrol:
100 mg - day 1
80 mg - day 2
60 mg - day 3
40 mg - day 4
Prednisolone:
20 mg - day 5
15 mg - day 14
12.5 mg - day 21
10 mg - day 28
7.5 mg - day 60
5 mg - day 90
(D/C at day 360)		 Preop:
50 mg Solu-Medrol IV
Intraop:
1 gm Solu-Cortef
Postop:
taper Solu-Medrol:
100 mg - day 1
80 mg - day 2
60 mg - day 3
40 mg - day 4
Prednisolone:
20 mg - day 5
15 mg - day 14
12.5 mg - day 21
10 mg - day 28
7.5 mg - day 60
5 mg - day 90
(D/C at day 360)		 Preop:
50 mg Solu-Medrol IV
Intraop:
1 gm Solu-Cortef
Postop:
taper Solu-Medrol:
200 mg - day 1
160 mg - day 2
120 mg - day 3
80 mg - day 4
40 mg - day 4
Prednisolone:
20 mg - day 6
15 mg - day 60
12.5 mg - day 90
10 mg - day 180
7.5 mg - day 270
5 mg - day 360		 Preop:
50 mg Solu-Medrol IV
Intraop:
1 gm Solu-Cortef
Postop:
taper Solu-Medrol:
100 mg - day 1
80 mg - day 2
60 mg - day 3
40 mg - day 4
Prednisolone:
20 mg - day 5
15 mg - day 14
12.5 mg - day 21
10 mg - day 28
7.5 mg - day 60
5 mg - day 90

* Use gelcaps when dose is less than 500 mg every 12 hours.
** Adjust for WBC.

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