From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Immunosuppressant medications for transplant patients should generally be restarted as soon as possible after major surgery, typically within 24-48 hours, once the patient is hemodynamically stable and able to tolerate oral medications. For calcineurin inhibitors like tacrolimus (Prograf) and cyclosporine (Neoral, Sandimmune), restart at the pre-operative dose once the patient can take oral medications, with therapeutic drug monitoring to ensure appropriate blood levels 1. Mycophenolate mofetil (CellCept) or mycophenolic acid (Myfortic) can be restarted at the pre-operative dose when the patient is tolerating oral intake and showing no signs of significant gastrointestinal complications. Corticosteroids (prednisone, methylprednisolone) should be continued throughout the perioperative period, potentially with stress-dose coverage during surgery, and then tapered back to maintenance doses.
Some key points to consider when restarting immunosuppressant medications include:
- The importance of individualized drug use, as highlighted in the study by 1, which discusses the mechanism of immunosuppressants and current therapeutic protocols in transplantation.
- The need for close monitoring of renal function, liver function, complete blood count, and drug levels during the restart period, as emphasized in various studies 2, 3, 4, 5.
- The balance between the risk of rejection and concerns about wound healing and infection risk, with the transplanted organ's protection generally taking priority in most cases.
In terms of specific medications, the study by 5 compared the combination of cyclosporine A, mycophenolate mofetil, and steroids with tacrolimus, mycophenolate mofetil, and steroids as primary therapy after primary lung transplantation, and found similar results in terms of patient survival and freedom from acute rejection. However, the most recent and highest quality study, 1, provides the most relevant guidance on the use of immunosuppressant medications in transplant patients.
Overall, the key is to restart immunosuppressant medications as soon as possible after major surgery, while carefully monitoring the patient's condition and adjusting the medication regimen as needed to minimize the risk of rejection and other complications. The goal is to balance the risk of rejection with concerns about wound healing and infection risk, while prioritizing the protection of the transplanted organ.