Na: 141 mEq/L (141 mmol/L) K: 4.9 mEq/L (4.9 mmol/L) Cl: 100 mEq/L (100 mmol/L) CO2: 22 mEq/L (22 mmol/L) BUN: 22 mg/dL (7.9 mmol/L) SCr: 1.2 mg/dL (106 pmol/L) Glucose: 89 mg/dL (4.9 mmol/L)

Lipid panel: Total cholesterol = 271 mg/dL (7.0 mmol/L); LDL-C = 180 mg/dL (4.7 mmol/L); HDL = 30 mg/dL (0.8 mmol/L); triglycerides = 325 mg/dL (3.7 mmol/L)

VS: BP 154/95 mm Hg (152/88 mm Hg repeated); HR 60 bpm

Meds: Tacrolimus 3 mg by mouth twice a day; mycophenolate mofetil 1,000 mg by mouth twice a day; prednisone 10 mg by mouth once a day; atovaquone 1,500 mg by mouth once a day; valganciclovir 450 mg by mouth once a day; vitamin D 800 IU by mouth once a day; calcium carbonate 1,250 mg by mouth twice a day separated from food and mycophenolate; simvastatin 20 mg by mouth once a day at bedtime; meto-prolol 100 mg by mouth twice a day; amlodipine 10 mg by mouth once a day; ASA 81 mg by mouth once a day; zolpidem 10 mg by mouth once a day at bedtime

Identify why JJ is taking each agent listed.

What are some treatment options, in addition to Metoprolol 100 mg twice daily and Amlodipine 10 mg daily, for JJ's elevated blood pressure?

Design a monitoring plan for JJ's therapy. Post-transplant Lymphoproliferative Disorders

© Post-transplant lymphoproliferative disorders (PTLD) are a major complication in patients following organ transplantation.81 Large series of case reports have demonstrated that the incidence of PTLD is 1% for renal patients, 1.8% for cardiac patients, 2.2% for liver patients, and 9.4% for heart-lung patients. The risk of developing non-Hodgkin's lymphoma is 28- to 49-fold higher in solid organ transplant recipients compared with the general population. Another independent risk factor is the pres-

ence of the Epstein-Barr virus (EBV). Lymphomas are the most common form of lymphoproliferative disease found in transplant recipients.81

The incidence of disease depends on certain factors. These factors include the type of organ transplanted, the age of the transplant recipient, the degree of immunosup-

81 83

pression, the type of immunosuppression, and exposure to EBV. ' The mortality rate in these patients is about 50%, with most patients dying shortly after diagnosis. It has also been demonstrated that the risk of developing PTLD is greater in the popula-

tion of EBV seronegative patients at the time of transplant.

Another risk factor for the development of PTLD is the type of immunosuppressive regimens used. ALAs have come to be widely used in the prevention and treatment of acute rejection. These agents work by causing widespread T-cell lysis. Immun-osuppressive regimens utilizing the ALAs have been proven to increase the risk of PTLD.81


^^ Treatment for PTLD is still controversial; however, the most common treatment

options include reduction of immunosuppression, chemotherapy, and anti-B cell monoclonal antibodies.81 PTLD continues to be a long-term complication of prolonged immunosuppression. Current treatment options are all associated with certain risks. Prevention is the most effective treatment for PTLD. A better understanding in future of the disease process and the risk factors involved with the development of PTLD will aid in the prophylaxis and treatment of this disorder.

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