CST

RSW

Induction Therapy

Anti-thymocyte globulin 1.5 mg/kg × 4 doses (maximum 100 mg/ day)

Methylprednisolone

Anti-thymocyte globulin 1.5 mg/kg (ideal body weight) × 5 doses (no maximum dose)

Methylprednisolone

Maintenance immunosuppression

Tacrolimus (trough level)

・ 0 - 6 months - 6 - 9 ng/mL

・ >6 months - 4 - 7 ng/mL

Mycophenolate mofetil 1000 mg bid or mycophenolate sodium 720 mg bid

Prednisone taper to 5 mg daily by 1 month

Tacrolimus (trough level)

・ 0 - 2 months - 8 - 12 ng/mL

・ >2 months - 5 - 10 ng/mL

Mycophenolate mofetil 1000 mg bid or mycophenolate sodium 720 mg bid

Prednisone tapered off by day 6

Infection Prophylaxis

CMV

・ Valganciclovir for 3 months

・ Acyclovir × 1 month for low-risk

Pneumocystis

・ TMP/SMX single strength daily x 6 months

・ TMP/SMX single strength three times weekly indefinitely

Fungal

・ Oral Fluconazole × 1 month

CMV

・ Valganciclovir for 6 months

・ Acyclovir × 1 month for low-risk

Pneumocystis

・ TMP/SMX single strength daily × 12 months

Fungal

・ Oral nystatin × 5 days

Diagnosis and Management of Rejection

Biopsy-proven only

Banff 1A/1B

・ Methylprednisolone 500 mg daily × 3 days

・ Oral taper afterwards

Banff 2A/2B/3

・ Anti-thymocyte globulin

Empiric or biopsy-proven

Banff 1A/1B/Empiric

・ Methylprednisolone 500 mg daily × 3 days

Banff 2A/2B/3

・ Anti-thymocyte globulin