Table 3

Actionable events in preimmunosuppression comorbidity screening

Suspicion of parenchymal lung diseaseSmoking cessation advice
Lung function tests
X-ray of the chest±high-resolution CT scan of the chest
Consider referral to a respiratory physician
HIV, HBV and HCVConsider antiviral treatment prior to immunosuppression (discuss with specialist)
Abnormal liver biochemistry (AST or ALT>100 IU/L)Not an absolute contraindication
Select less hepatotoxic drug: MMF instead of AZA
Abnormal synthetic liver functionNot an absolute contraindication
Increased risk of toxicity, except MMF
Chronic renal impairment (CRI)Investigate cause for newly identified CRI
Alter dose/frequency and monitoring (table 14)
Cardiovascular riskPrimary prevention pretreatment
Previous malignancyNot an absolute contraindication
Routine population screening recommended
  • ALT, alanine transaminase; AST, aspartate aminotransferase; AZA, azathioprine; HBV, hepatitis B virus; HCV, hepatitis C virus; MMF, mycophenolate mofetil; MTX, methotrexate.