Intestine Follow-up Instructions

Intestine Transplant Recipient Follow-up (TRF)
Record Field Descriptions
Transplant Recipient Follow-up (TRF) records are generated in Tiedi® at six months, one year
and annually thereafter following transplantation, until either graft failure, recipient death or lost
to follow-up is reported.
The Intestine Transplant Recipient Follow-up (TRF) record is to be completed by the transplant
center responsible for follow-up of the recipient at intervals of six months, one year and
annually thereafter. The record is to contain only the applicable patient information since the
last follow-up period. It is not to contain information pertaining solely to the previous or next
follow-up period. For example: the 6-month follow-up should contain information from the time
after the TRR was completed to the 6-month transplant anniversary date; the 1-year follow-up
should contain information from the day after the 6-month transplant anniversary date to the 1year transplant anniversary date; the 2-year follow-up should contain information from the day
after the 1-year transplant anniversary date to the 2-year anniversary date.
If the recipient dies or experiences a graft failure between follow-up intervals, complete an
interim record containing the information pertinent to death or graft failure.
TRF records generated before June 30, 2002 are forgiven except for the one-year, three-year,
death/graft failure or most recently expected follow-up record. Amnesty records may be
accessed by selecting the Expected/Amnesty and/or Amnesty option on the Search page.
(For additional information, see Accessing Patient Records and Records Generation.)
If the patient is lost to follow-up, follow the steps for Reporting Lost to Follow-up.
View OPTN/UNOS Policy on Data Submission Requirements for additional information.
To correct information that is already displayed on an electronic record, call 1-800-978-4334.
Recipient Information
Name: Verify the last name, first name and middle initial of the transplant recipient is correct. If
the information is incorrect, corrections may be made on the recipient's TCR record.
DOB: Verify the displayed date is the recipient's date of birth. If the information is incorrect,
corrections may be made on the recipient's TCR record.
SSN: Verify the recipient's social security number is correct. If the information is incorrect,
contact the Help Desk at 1-800-978-4334.
Gender: Verify the recipient's gender is correct. If the information is incorrect, corrections may
be made on the recipient's TCR record.
HIC: Verify the 9 to 11 character Health Insurance Claim number for the recipient indicated on
the recipient's most recently updated TCR record is correct. If the recipient does not have a HIC
number, you may leave this field blank.
Tx Date: The recipient's transplant date, reported in the Recipient Feedback, will display. Verify
the transplant date is the date of the beginning of the first anastomosis. If the operation started
in the evening and the first anastomosis began early the next morning, the transplant date is
the date that the first anastomosis began. The transplant is considered complete when the
cavity is closed and the final skin stitch/staple is applied.
Previous Follow-up: The recipient's follow-up status, reported in the previous TRF record, will
display. Verify the recipient's previous follow-up status is correct.
Previous Px Stat Date: The recipient's patient status date, reported in the previous TRF
record, will display. Verify the recipient's previous patient status date is correct.

Transplant Discharge Date: Enter the date the recipient was released to go home, or verify
that the discharge date displayed is the date the recipient was released to go home. The
patient's hospital stay includes total time spent in different units of the hospital, including
medical and rehab. This is a required field.
Note: The Transplant Discharge Date can only be edited on the patient's TRR, 6-month
TRF and 1-year TRF. To correct this information on a follow-up that is after the 1year TRF, access one of these three records and enter the correct date. The
corrected information will automatically update on the other records.
State of Permanent Residence: Select the name of the state, of the recipient's permanent
address, at the time of follow-up.
Zip Code: Enter the recipient's zip code, of their permanent address, at the time of follow-up.
Provider Information
Recipient Center: The recipient center will display. Verify the transplant center name and the
center code, and the provider number, (6-character Medicare identification number of the
hospital where the transplant recipient was transplanted) are correct.
Followup Center: The follow-up center, reported in the recipient's previous validated TRF
record, will display. Verify the center name, center code and provider number for the center
following the patient.
Physician Name: Enter the name of the physician who is following the patient.
NPI #: Enter the 10-character CMS (Center for Medicare and Medicaid Services, formerly
HCFA) assigned National Provider Identifier of the transplant physician. Your hospital billing
office may be able to obtain this number for you.
Follow-up Care Provided By: Indicate where the follow-up care was provided. If Other
Specify is selected, specify the provider in the space provided.
Transplant Center
Non Transplant Center Specialty Physician
Primary Care Physician
Other Specify
Donor Information
UNOS Donor ID #: The UNOS Donor ID number, reported in the Recipient Feedback, will
display. Each potential donor is assigned an identification number by OPTN/UNOS. This ID
number corresponds to the date the donor information was entered into the OPTN/UNOS
computer system.
Donor Type: The donor type, reported in the Recipient Feedback, will display. Verify the
recipient's donor type is correct. If the information is incorrect, contact the Help Desk at 1-800978-4334.
Deceased indicates the donor was not living at the time of donation.
Living indicates the donor was living at the time of donation.
Patient Status (At Time Of Follow-Up)
Date: Last Seen, Retransplanted or Death: Enter the date the patient was last seen, the date
of death, or the date of retransplant for this recipient, using the standard 8-digit numeric format
of MM/DD/YYYY. The follow-up records (6-month, 1-year, 2-year, etc.) are to be completed
within 30 days of the 6-month and yearly anniversaries of the transplant date. If the recipient
died or the graft failed, and you have not completed an interim follow-up indicating these
events, the 6-month and annual follow-ups should be completed indicating one of those two
events.

Patient Status: If the recipient is living at the time of follow-up, select Living. If the recipient
died during this follow-up period, select Dead. If the recipient received another kidney from a
different donor during the follow-up period, select Retransplanted. If Dead is selected, indicate
the cause of death.
Living
Dead
Retransplanted
Primary Cause of Death: If the Patient Status is Dead, select the patient's cause of
death. If an Other code is selected, enter the other cause of death in the space
provided.
Contributory Cause of Death: If the Patient Status is Dead, select the patient's
contributory cause of death. If an Other code is selected, enter the other cause of
death in the space provided.
Contributory Cause of Death: If the Patient Status is Dead, select the patient's
contributory cause of death. If an Other code is selected, enter the other cause of
death in the space provided.
Hospitalizations:
Has the patient been hospitalized since the last patient status date: If the recipient has
been hospitalized since the last patient status report, regardless of patient status (living,
dead, or retransplanted), select Yes. If not, select No. If unknown, select UNK. If Yes is
selected, indicate the number of hospitalizations.
Note: Hospitalizations should ONLY include inpatient visits.
Number of Hospitalizations: If the recipient was hospitalized, enter the number of
hospitalizations. This field is optional.
Noncompliance:
Was there evidence of noncompliance with immunosuppression medication during
this follow-up period that compromised the patient's recovery: If the recipient had
been noncompliant during this follow-up period, select Yes. If not, select No. If unknown,
select UNK. This field is optional.
Functional Status: Select the choice that best describes the recipient's functional status just
prior to the time of transplant.
Note: The Karnofsky Index will display for adults aged 18 and older.
10% - Moribund, fatal processes progressing rapidly
20% - Very sick, hospitalization necessary: active treatment necessary
30% - Severely disabled: hospitalization is indicated, death not imminent
40% - Disabled: requires special care and assistance
50% - Requires considerable assistance and frequent medical care
60% - Requires occasional assistance but is able to care for needs
70% - Cares for self: unable to carry on normal activity or active work
80% - Normal activity with effort: some symptoms of disease
90% - Able to carry on normal activity: minor symptoms of disease
100% - Normal, no complaints, no evidence of disease
Unknown
Note: The Lansky Scale will display for pediatrics aged 1 to 17.
10% - No play; does not get out of bed
20% - Often sleeping; play entirely limited to very passive activities
30% - In bed; needs assistance even for quiet play
40% - Mostly in bed; participates in quiet activities

50% - Can dress but lies around much of day; no active play; can take part in quiet
play/activities
60% - Up and around, but minimal active play; keeps busy with quieter activities
70% - Both greater restriction of and less time spent in play activity
80% - Active, but tires more quickly
90% - Minor restrictions in physically strenuous activity
100% - Fully active, normal
Not Applicable (patient < 1 year old)
Unknown
Note: This evaluation should be in comparison to the person's normal function, indicating
how the patient's disease has affected their normal function.
Physical Capacity: Select the choice that best describes the recipient’s physical capacity at
the time of listing. If the recipient's Medical Condition indicates they are hospitalized, select
Not Applicable (hospitalized). This field is optional for adult recipients only.
No Limitations
Limited Mobility
Wheelchair bound or more limited
Not Applicable (hospitalized)
Unknown
Physical Capacity is the ability to perform bodily activities such as walking, dressing,
bathing, grooming, etc.
Cognitive Development: (Complete for recipients younger than 18 years of age at transplant
and younger than 26 years of age at follow-up.) Select the choice that best describes the
recipient's cognitive development at the time of listing.
Definite Cognitive Delay/Impairment (verified by IQ score <70 or unambiguous
behavioral observation)
Probable Cognitive Delay/Impairment (not verified or unambiguous but more likely than
not, based on behavioral observation or other evidence)
Questionable Cognitive Delay/Impairment (not judged to be more likely than not, but
with some indication of cognitive delay/impairment such as expressive/receptive language
and/or learning difficulties)
No Cognitive Delay/Impairment (no obvious indicators of cognitive delay/impairment)
Not Assessed
Motor Development: (Complete for recipients younger than 18 years of age at transplant and
younger than 26 years of age at follow-up.) Select the choice that best describes the recipient's
motor development at the time of listing.
Definite Motor Delay/Impairment (verified by physical exam or unambiguous behavioral
observation)
Probable Motor Delay/Impairment (not verified or unambiguous but more likely than not,
based on behavioral observation or other evidence)
Questionable Motor Delay/Impairment (not judged to be more likely than not, but with
some indication of motor delay/impairment)
No Motor Delay/Impairment (no obvious indicators of motor delay/impairment)
Not Assessed
Working for income: (Complete for recipients 19 years of age or older.) If the recipient was
working for income at the time of follow-up, select Yes. If not, select No. If reporting the
recipient's death, indicate if the recipient was working for income just prior to death.

If Yes: If Yes is selected, indicate the recipient's working status. (This field is optional for
adult recipients only).
Working Full Time
Working Part Time due to Demands of Treatment
Working Part Time due to Disability
Working Part Time due to Insurance Conflict
Working Part Time due to Inability to Find Full Time Work
Working Part Time due to Patient Choice
Working Part Time Reason Unknown
Working, Part Time vs. Full Time Unknown
If No, Not Working Due To: If No is selected, indicate the reason why the recipient was
not working. (This field is optional for adult recipients only).
Disability - A physical or mental impairment that interferes with or prevents a recipient
from working (e.g. arthritis, mental retardation, cerebral palsy, etc).
Demands of Treatment - An urgent medical treatment that prevents a recipient from
working (e.g. Dialysis).
Insurance Conflict - Any differences between a recipient and insurance company that
prevents them from working.
Inability to Find Work - The lack of one's ability to find work. (e.g. lack of
transportation, work experience, over qualification, unavailable work, etc.)
Patient Choice - Homemaker - A recipient who chooses to manage their own
household, instead of performing work for pay.
Patient Choice - Student Full Time/Part Time - A recipient who is enrolled and/or
participating in college.
Patient Choice - Retired - A recipient who no longer has an active working life such as
an occupation, business or office job.
Patient Choice - Other - Any reason not listed above that would prevent a recipient
from working.
Not Applicable - Hospitalized - Select only if the patient's Medical Condition indicates
they are in the hospital.
Unknown
Academic Progress: (Complete for recipients 18 years of age or younger.) Select the choice
that best describes the recipient's academic progress at the time of follow-up. If reporting the
recipient's death, select the choice that best describes the recipient's progress just prior to
death.
Within One Grade Level of Peers
Delayed Grade Level
Special Education
Not Applicable < 5 years old
Status Unknown
Academic Activity Level: (Complete for recipients 18 years of age or younger.) Select the
choice that best describes the recipient's academic activity level at the time of follow-up. If
reporting the recipient's death, select the choice that best describes the recipient's academic
activity just prior to death.
Full academic load
Reduced academic load
Unable to participate in academics due to disease or condition

Not Applicable < 5 years old/High School graduate
Status Unknown
Primary Insurance at Follow-up: Select the recipient's source of primary payment (largest
contributor) during the follow-up period.
Private insurance refers to funds from agencies such as Blue Cross/Blue Shield, etc. It
also refers to any worker's compensation that is covered by a private insurer.
Public insurance - Medicaid refers to state Medicaid funds.
Public insurance - Medicare FFS (Fee-for-Service) refers to funds, from the government
in which doctors and other health care providers are paid for each service provided to a
recipient. For additional information about Medicare, see
http://www.medicare.gov/Choices/Overview.asp.
Public insurance - Medicare & Choice (also known as Medicare Managed Care) refers
to funds from the government in which doctors and other health care providers are paid for
each service provided to a recipient, along with additional benefits (i.e., coordination of care
or reducing-out-of-pocket expenses. Sometimes a recipient may receive additional benefits
such as prescription drugs). For additional information about Medicare, see
http://www.medicare.gov/Choices/Overview.asp.
Public insurance - CHIP (Children's Health Insurance Program)
Public insurance - Department of VA refers to funds from the Veterans Administration.
Public insurance - Other government
Self indicates that the cost of follow-up will be paid for by the recipient.
Donation indicates that a company, institution, or individual(s) donated funds to pay for the
follow-up period and care of the recipient.
Free Care indicates that the transplant hospital will not charge recipient for the costs of the
follow-up period.
Foreign Government refers to funds provided by foreign government (Primary only).
Specify foreign country in the space provided.
Unknown
Clinical Information
Date of Measurement: (Complete for recipients younger than 18 years of age at transplant
and younger than 26 years of age at follow-up.) Enter the date, using the 8-digit format of
MM/DD/YYYY, the recipient’s height and weight were measured.
Height: Enter the height of the recipient at the time of discharge in the appropriate space, in
feet and inches or centimeters. If the recipient’s height is unavailable, select the appropriate
status from the ST field (N/A, Not Done, Missing, Unknown). For recipients 18 years old or
younger at the time of listing, UNet will generate and display calculated percentiles based on
the 2000 CDC growth charts. (This field is optional for adult recipients only).
Weight: Enter the weight of the recipient at the time of discharge in the appropriate space, in
pounds or kilograms. If the recipient’s weight is unavailable, select the appropriate status from
the ST field (N/A, Not Done, Missing, Unknown). For recipients 18 years old or younger at the
time of listing, UNet will generate and display calculated percentiles based on the 2000 CDC
growth charts. (This field is optional for adult recipients only).
BMI (Body Mass Index): For recipients 18 years old or younger during the follow-up period,
UNet will generate and display calculated percentiles based on the 2000 CDC growth charts.
Percentiles are the most commonly used clinical indicator to assess the size and growth
patterns of individual children in the United States. Percentiles rank the position of an

individual by indicating what percent of the reference population the individual would equal
or exceed (i.e. on the weight-for-age growth charts, a 5 year-old girl whose weight is at the
25th percentile, weighs the same or more than 25 percent of the reference population of 5year-old girls, and weighs less than 75 percent of the 5-year-old girls in the reference
population). For additional information about CDC growth charts, see http://www.cdc.gov/.
Graft Status: If the graft is functioning at the time of follow-up, select Functioning. If the graft
is not functioning at the time of follow-up, select Failed.
Note: If death is indicated for the recipient, and the death was a result of some other factor
unrelated to graft failure, select Functioning.
If Functioning, select Yes or No for each of the following fields:
TPN Dependent: If the recipient is dependent on total parenteral nutrition, select Yes.
If not, select No.
IV Dependent: If the recipient is dependent on intravenous fluids, select Yes. If not,
select No.
Oral Feeding: If the recipient is receiving oral nutrition, select Yes. If not, select No.
Tube Feeding: If the recipient is receiving nutrition via any gastric tube, select Yes. If
not, select No.
If Failed, provide the following information:
Date of Failure: Enter the date of graft failure using the standard 8-digit numeric format
of MM/DD/YYYY.
Primary Cause of Failure: Select the cause of graft failure. If Other Specify is
selected, enter the cause of graft failure in the space provided.
Recurrent Tumor
Acute Rejection
Chronic Rejection
Technical Problems
Infection
Lymphoproliferative Disease
Patient Noncompliance
GVHD (Graft vs. Host Disease) (Pediatric recipients only)
Ischemia/NEC (Necrotizing Entercolitis) Like Syndrome (Pediatric recipients
only)
Other Specify
Diabetes onset during the follow-up period: If the recipient developed diabetes during the
follow-up period, select Yes. If not, select No. If unknown, select UNK. If Yes is selected,
indicate whether the recipient was dependent on insulin.
If yes, insulin dependent: If the recipient is insulin dependent, select Yes. If not, select
No. If unknown, select UNK.
Most Recent Lab data:
Lab Date: Enter date, using the standard 8-digit numeric format of MM/DD/YYYY, when
samples were drawn and laboratory tests were performed closest to the end of this current
follow-up period.
Total Bilirubin: Enter the lab value for total serum bilirubin in mg/dl taken closest to the
time of follow-up. If the value is not available, select the status from the ST field (N/A, Not
Done, Missing, Unknown). (This field is optional for adult recipients only.)

Serum Albumin: Enter the lab value for the serum albumin value in g/dl taken closest to
the time of follow-up. If the value is not available, select the status from the ST field (N/A,
Not Done, Missing, Unknown). This field is optional.
Serum Creatinine: Enter the lab value for the serum creatinine value in mg/dl taken
closest to the time of follow-up. If the value is not available, select the status from the ST
field (N/A, Not Done, Missing, Unknown).
Did patient have any acute rejection episodes during the follow-up period: If the recipient
experienced at least one episode during this follow-up period, select Yes. If not, select No. If
unknown, select Unknown. If Yes is selected, indicate if a biopsy was done to confirm acute
rejection.
Yes, at least one episode treated with anti-rejection agent
Yes, none was treated with additional anti-rejection agent
No
Unknown
Was Biopsy done to confirm acute rejection: If the recipient had an acute kidney
rejection episode, indicate whether biopsy confirmed acute rejection by selecting Yes. If a
biopsy was not done, select Biopsy not done. If unknown, select Unknown. This field is
optional.
Biopsy not done
Yes, rejection confirmed
Yes, rejection not confirmed
Unknown
Postransplant Malignancy: If the recipient has been diagnosed with any malignant cancer
since the last follow-up, select Yes. If not, select No. If unknown, select UNK. If Yes is
selected, at least one of the fields listed below must be completed. A Post Transplant
Malignancy record will generate when one or more of the fields listed below is selected. For
additional information, see Post Transplant Malignancy Record Fields.
Donor Related: If the malignancy is donor related, select Yes . If not, select No. If
unknown, select UNK. If Yes is selected, the Donor Related section will be displayed on
the Post Transplant Malignancy record. For additional information, see Post Transplant
Malignancy Record Fields - Donor Related.
Recurrence of Pre-Tx tumor: If a pre-transplant tumor has recurred, select Yes. If not,
select No. If unknown, select UNK. If Yes is selected, the Recurrence of Pretransplant
Malignancy section will be displayed on the Post Transplant Malignancy record. For
additional information, see Post Transplant Malignancy Record Fields - Recurrence of
Pretransplant Malignancy.
De Novo Solid Tumor: If the cancer was a De Novo solid tumor, select Yes If not, select
No. If unknown, select UNK. If Yes is selected, the Post Transplant De Novo Solid Tumor
section will be displayed on the Post Transplant Malignancy record. For additional
information, see Post Transplant Malignancy Record Fields - Post Transplant De Novo
Solid Tumor.
De Novo Lymphoproliferative disease and Lymphoma: If the cancer was post
transplant lymphoproliferative disease or lymphoma, select Yes . If not, select No. If
unknown, select UNK. If Yes is selected, the Post Tx Lymphoproliferative Disease and
Lymphoma section will be displayed on the Post Transplant Malignancy record. For
additional information, see Post Transplant Malignancy Record Fields - Post Tx
Lymphoproliferative Disease and Lymphoma.
Note: Please report each type of malignancy only once in the follow-up process.
Note: When a patient has a tumor during one follow-up period and the tumor continues
into the next follow-up period without going away, the tumor should only be

reported on that first follow-up record and not reported on the next follow-up
record. The tumor should be reported on subsequent follow-up records ONLY if
the tumor goes away and then returns in the next follow-up period.
Treatment
Biological or Anti-viral Therapy: If biological or anti-viral therapy is being administered to the
recipient, select Yes. If not, select No. If unknown or can't disclose, select Unknown/Cannot
Disclose. If Yes is selected, check all that apply. If a therapy, other than those listed, was
administered, select Other, Specify and enter the therapy in the space provided. These fields
are optional.
Acyclovir (Zovirax)
Cytogam (CMV)
Gamimune
Gammagard
Ganciclovir (Cytovene)
Valgancyclovir (Valcyte)
HBIG (Hepatitis B Immune Globulin)
Flu Vaccine (Influenza Virus)
Lamivudine (Epivir) (for treatment of Hepatitis B)
Valacyclovir (Valtrex)
Other, Specify
Other Therapies: If the recipient received other therapies, select Yes. If not, select No. If Yes
is selected, check all that apply: These fields are optional.
Photopheresis
Plasmapheresis
Total Lymphoid Irradiation (TLI)
Note: If the recipient was removed from the waiting list with a code 21, indicating the recipient
died during the transplant procedure, select No for all Biologicals or Anti-viral.
Immunosuppressive Information
Previous Validated Maintenance Follow-up Medications: The follow-up Immunosuppression
medication(s) indicated in the patient's most recently validated Transplant Recipient
Registration (TRR) or Transplant Recipient Follow-up (TRF) record will be listed.
Note: If a drug cannot be indicated as Maintenance in the Transplant Recipient
Registration (TRR), then it cannot be indicated as Current Maintenance or Previous
Maintenance in the TRF. If the drug cannot be indicated as Anti-rejection in the
TRR, then it cannot be indicated as Anti-rejection in the TRF.
Were any medications given during the follow-up period for maintenance: If there
have been no changes in medications during this follow-up period, select Yes same as
previous validated report. The immunosuppressive medications selected as Current on
the previous validated report will automatically be checked off in the Previous and Current
columns of this follow-up record. If there have been changes in medications during this
follow-up period, select Yes, but different than previous validated report. Then select
the appropriate Immunosuppressive Medications. If no medications were given during this
follow-up period, select None given.
Note: If any medications were given during the 6-month follow-up period for
maintenance, immunosuppression medications from the patient's validated TRR
will be listed.
Did the physician discontinue all maintenance immunosuppressive medications: If
the physician discontinued the patients immunosuppressive medications, select Yes. If the

patient stopped the medications themselves or they were stopped for some other reason,
select No.
Did the patient participate in any clinical research protocol for immunosuppressive
medications: If the recipient participated in clinical research, select Yes. If not, select No.
If Yes is selected, enter the details in the space provided. This field is optional.
Immunosuppressive Medications
For each of the immunosuppressant medications listed, check Previous Maintenance (Prev
Maint), Current Maintenance (Curr Maint) or Anti-rejection (AR) to indicate all medications
that were prescribed for the recipient during this follow-up period, and for what reason. If a
medication was not given, leave the associated box(es) blank.
Previous Maintenance (Prev Maint) includes all immunosuppressive medications given
during the report period, which covers the period from the last clinic visit to the current clinic
visit, for varying periods of time which may be either long-term or intermediate term with a
tapering of the dosage until the drug is either eliminated or replaced by another long-term
maintenance drug (e.g., Prednisone, Cyclosporine, Tacrolimus, Mycophenolate Mofetil,
Azathioprine, or Rapamycin). This does not include any immunosuppressive medications
given to treat rejection episodes.
Current Maintenance (Curr Maint) includes all immunosuppressive medications given at
the time of the current clinic visit to begin in the next report period for varying periods of
time which may be either long-term or intermediate term with a tapering of the dosage until
the drug is either eliminated or replaced by another long-term maintenance drug (e.g.,
Prednisone, Cyclosporine, Tacrolimus, Mycophenolate Mofetil, Azathioprine, or
Rapamycin). This does not include any immunosuppressive medications given to treat
rejection episodes.
Note: If the recipient was taking maintenance medications during the follow-up period
but is now deceased, then select Yes, but different than previous validated
report, and check-off all applicable medications in the Previous column only. Do
not check-off any medications in the Current column.
Note: On Recipient Death (RD) records, any maintenance medications given during
the follow-up period should be noted as Previous, and nothing should be noted
in the Current column.
Anti-rejection (AR) immunosuppression includes all immunosuppressive medications
given for the purpose of treating an acute rejection episode since the last clinic visit (e.g.,
Methylprednisolone, Atgam, OKT3, or Thymoglobulin). When switching maintenance drugs
(e.g., from Tacrolimus to Cyclosporine; or from Mycophenolate Mofetil to Azathioprine)
because of rejection, the drugs should not be listed under AR immunosuppression, but
should be listed under maintenance immunosuppression.
Note: The Anti-rejection field refers to any anti-rejection medications since the last
clinic visit, not just at the time of the current clinic visit.
Note: As further clarification, drugs that are used with the intention to maintain
recipients long-term are medications such as Tacrolimus, Cyclosporine,
Azathioprine, Mycophenolate Mofetil and Prednisone. These maintenance
medications should not be listed as AR medications to treat acute rejection.
When patients have a true acute rejection, they are given anti-rejection
medication such as steroids, OKT3, ATG, Simulect and Zenapax, in addition to
the maintenance medications. These are the medications that should be selected
as anti-rejection.
If an immunosuppressive medication other than those listed is being administered (e.g., new
monoclonal antibodies), select Previous Maint, or Current Maint, or AR next to Other

Immunosuppressive Medication field, and enter the full name of the medication in the space
provided. Do not list non-immunosuppressive medications.
Other Immunosuppressive Medications
For each of the immunosuppressant medications listed, check Previous Maintenance (Prev
Maint), Current Maintenance (Curr Maint) or Anti-rejection (AR) to indicate all medications
that were prescribed for the recipient during this follow-up period, and for what reason. If a
medication was not given, leave the associated box(es) blank.
Previous Maintenance (Prev Maint) includes all immunosuppressive medications given
during the report period, which covers the period from the last clinic visit to the current clinic
visit, for varying periods of time which may be either long-term or intermediate term with a
tapering of the dosage until the drug is either eliminated or replaced by another long-term
maintenance drug (e.g., Prednisone, Cyclosporine, Tacrolimus, Mycophenolate Mofetil,
Azathioprine, or Rapamycin). This does not include any immunosuppressive medications
given to treat rejection episodes.
Current Maintenance (Curr Maint) includes all immunosuppressive medications given at
the time of the current clinic visit to begin in the next report period for varying periods of
time which may be either long-term or intermediate term with a tapering of the dosage until
the drug is either eliminated or replaced by another long-term maintenance drug (e.g.,
Prednisone, Cyclosporine, Tacrolimus, Mycophenolate Mofetil, Azathioprine, or
Rapamycin). This does not include any immunosuppressive medications given to treat
rejection episodes.
Note: On Recipient Death (RD) records, any maintenance medications given during
the follow-up period should be noted as Previous, and nothing should be noted
in the Current column.
Anti-rejection (AR) immunosuppression includes all immunosuppressive medications
given for the purpose of treating an acute rejection episode since the last clinic visit (e.g.,
Methylprednisolone, Atgam, OKT3, or Thymoglobulin). When switching maintenance drugs
(e.g., from Tacrolimus to Cyclosporine; or from Mycophenolate Mofetil to Azathioprine)
because of rejection, the drugs should not be listed under AR immunosuppression, but
should be listed under maintenance immunosuppression.
Note: The Anti-rejection field refers to any anti-rejection medications since the last
clinic visit, not just at the time of the current clinic visit.
Note: As further clarification, drugs that are used with the intention to maintain
recipients long-term are medications such as Tacrolimus, Cyclosporine,
Azathioprine, Mycophenolate Mofetil and Prednisone. These maintenance
medications should not be listed as AR medications to treat acute rejection.
When patients have a true acute rejection, they are given anti-rejection
medication such as steroids, OKT3, ATG, Simulect and Zenapax, in addition to
the maintenance medications. These are the medications that should be selected
as anti-rejection.
If an immunosuppressive medication other than those listed is being administered (e.g., new
monoclonal antibodies), select Previous Maint, or Current Maint, or AR next to Other
Immunosuppressive Medication field, and enter the full name of the medication in the space
provided. Do not list non-immunosuppressive medications.
Investigational Immunosuppressive Medications
For each of the immunosuppressant medications listed, check Previous Maintenance (Prev
Maint), Current Maintenance (Curr Maint) or Anti-rejection (AR) to indicate all medications
that were prescribed for the recipient during this follow-up period, and for what reason. If a
medication was not given, leave the associated box(es) blank.

Previous Maintenance (Prev Maint) includes all immunosuppressive medications given
during the report period, which covers the period from the last clinic visit to the current clinic
visit, for varying periods of time which may be either long-term or intermediate term with a
tapering of the dosage until the drug is either eliminated or replaced by another long-term
maintenance drug (e.g., Prednisone, Cyclosporine, Tacrolimus, Mycophenolate Mofetil,
Azathioprine, or Rapamycin). This does not include any immunosuppressive medications
given to treat rejection episodes.
Current Maintenance (Curr Maint) includes all immunosuppressive medications given at
the time of the current clinic visit to begin in the next report period for varying periods of
time which may be either long-term or intermediate term with a tapering of the dosage until
the drug is either eliminated or replaced by another long-term maintenance drug (e.g.,
Prednisone, Cyclosporine, Tacrolimus, Mycophenolate Mofetil, Azathioprine, or
Rapamycin). This does not include any immunosuppressive medications given to treat
rejection episodes.
Note: On Recipient Death (RD) records, any maintenance medications given during
this follow-up period should be noted as Previous, and nothing should be noted
in the Current column.
Anti-rejection (AR) immunosuppression includes all immunosuppressive medications
given for the purpose of treating an acute rejection episode since the last clinic visit (e.g.,
Methylprednisolone, Atgam, OKT3, or Thymoglobulin). When switching maintenance drugs
(e.g., from Tacrolimus to Cyclosporine; or from Mycophenolate Mofetil to Azathioprine)
because of rejection, the drugs should not be listed under AR immunosuppression, but
should be listed under maintenance immunosuppression.
Note: The Anti-rejection field refers to any anti-rejection medications since the last
clinic visit, not just at the time of the current clinic visit.
Note: As further clarification, drugs that are used with the intention to maintain
recipients long-term are medications such as Tacrolimus, Cyclosporine,
Azathioprine, Mycophenolate Mofetil and Prednisone. These maintenance
medications should not be listed as AR medications to treat acute rejection.
When patients have a true acute rejection, they are given anti-rejection
medication such as steroids, OKT3, ATG, Simulect and Zenapax, in addition to
the maintenance medications. These are the medications that should be selected
as anti-rejection.
If an immunosuppressive medication other than those listed is being administered (e.g., new
monoclonal antibodies), select Previous Maint, or Current Maint, or AR next to Other
Immunosuppressive Medication field, and enter the full name of the medication in the space
provided. Do not list non-immunosuppressive medications.
Drug Codes
Sandimmune (Cyclosporine A)
Neoral (CyA-NOF)
Tacrolimus (Prograf, FK506)
Sirolimus (RAPA, Rapamycin, Rapamune)
Leflunomide (LFL, Arava)
Azathioprine (AZA, Imuran)
Mycophenolate Mofetil (MMF, Cellcept, RS61443)
Cyclophosphamide (Cytoxan)
Methotrexate (Folex, PFS, Mexate-AQ, Rheumatrex)
Atgam (ATG)
OKT3 (Orthoclone, Muromonab)
Thymoglobulin
Zenapax - Daclizumab
Simulect - Basiliximab

Gengraf (Abbott Cyclosporine)
Everolimus (RAD, Certican)
EON (Generic Cyclosporine)
Myfortic (Mycophenolate Sodium)
Other generic Cyclosporine, specify brand:
Steroids (Prednisone,Methylprednisolone,Solumedrol,Medrol,Decadron)
Campath - Alemtuzumab (anti-CD52)
FTY 720
Rituximab
Modified Release Tacrolimus FK506E (MR4)
Other Immunosuppressive Medication, Specify
Other Immunosuppressive Medication, Specify