Table 2.
Immunosuppressive adverse effects scoring system with central nervous system and miscellaneous adverse effects
| Central nervous system adverse effects a | ||
|---|---|---|
|
Tremor |
|
|
| 0: |
None |
|
| 1+: |
Noticeable movement of paper suspended over outstretched hands with fingers spread |
|
| 2+: |
Prominent movement of suspended paper |
|
| 3+: |
Resting tremor and/or tremor that impairs function |
|
|
Headache |
|
|
| 0: |
Absent |
|
| 1+: |
Present |
|
|
Insomnia |
|
|
| 0: |
None |
|
| 1+: |
Difficulty sleeping |
|
| 2+: |
Noticeable loss of sleep; requires pharmacotherapy to achieve adequate sleep |
|
| 3+: |
Severe sleep deprivation; difficulty sleeping despite pharmacotherapy |
|
|
Miscellaneous adverse effects
a
| ||
|
Myopathy |
|
|
| 0: |
None |
|
| 1+: |
Complaints of muscle weakness or decreased strength |
|
| 2+: |
Clinically apparent weakness difficulty rising from chair or squatting position |
|
| 3+: |
Muscle wasting + severe limitation of exercise capacity |
|
|
Ophthalmic changes |
|
|
| 0: |
No cataract formation |
|
| 1+: |
Cataracts present; or surgical removal of cataracts has occurred |
|
|
Mania/Excitable behavior |
|
|
| 0: |
None |
|
| 1+: |
Excitable behavior; rapid speech and activity level |
|
| 2+: |
Very excitable behavior, actions and speech |
|
|
Depression |
|
|
| 0: |
None |
|
| 1+: |
Depressed thoughts with normal level of activity for patient ( no antidepressants) |
|
| 2+: |
Depressed thoughts with normal level of activity for patient ( with antidepressants) |
|
| 3+: |
Depressed thoughts without normal level of activity for patient ( does not dress, poor hygiene, etc.) and receives anti-depressants |
|
|
Post-transplant Diabetes mellitus |
Symptoms of diabetes plus casual plasma glucose ≥200 mg/dl |
OR |
| |
Fasting plasma glucose ≥126 mg/dl |
OR |
| (two of the criteria are required) |
2 hour plasma glucose ≥200 mg/dl during an oral glucose tolerance test |
OR |
| 0: Absent |
Glycated Hemoglobin A1C > 7% |
OR |
| 1+: Present |
Use of anti-diabetic agents |
|
|
General laboratory results | ||
| Renal function – Serum Creatinine (mg/dl) |
_____________________ |
|
| Blood pressure |
_____________________ |
|
| Glucose (mg/dl) |
_____________________ |
|
| Glycated hemoglobin A1C (%) |
_____________________ |
|
| Total cholesterol (mg/dl) |
_____________________ |
|
| High density lipoprotein (mg/dl) |
_____________________ |
|
| Low density lipoprotein (mg/dl) |
_____________________ |
|
| Triglycerides (mg/dl) |
_____________________ |
|
| Total white blood cells (cell/mm3) |
_____________________ |
|
| Neutrophils (%) |
_____________________ |
|
| Lymphocytes (%) |
_____________________ |
|
| Platelets (cells/mm3) |
_____________________ |
|
| Hemoglobin (g/dl) |
_____________________ |
|
| Hematocrit (%) | _____________________ | |
a The scoring system presents a quantitative severity rating of the most common adverse effects of immunosuppressive therapy. Each adverse effect was assessed as a change from pre-transplant status to document that the manifestation was attributed to immunosuppressive therapy or a change related therapy in the post-transplant period.