| 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 |