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Goldraich LA, Leitão SAT, Scolari FL, Marcondes-Braga FG, Bonatto MG, Munyal D, Harrison J, Ribeiro RVP, Azeka E, Piardi D, Costanzo MR, Clausell N. A Comprehensive and Contemporary Review on Immunosuppression Therapy for Heart Transplantation. Curr Pharm Des 2021; 26:3351-3384. [PMID: 32493185 DOI: 10.2174/1381612826666200603130232] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/20/2020] [Indexed: 11/22/2022]
Abstract
Heart transplantation is the standard of therapy for patients with end-stage heart disease. Since the first human-to-human heart transplantation, performed in 1967, advances in organ donation, surgical techniques, organ preservation, perioperative care, immunologic risk assessment, immunosuppression agents, monitoring of graft function and surveillance of long-term complications have drastically increased recipient survival. However, there are yet many challenges in the modern era of heart transplantation in which immunosuppression may play a key role in further advances in the field. A fine-tuning of immune modulation to prevent graft rejection while avoiding side effects from over immunosuppression has been the vital goal of basic and clinical research. Individualization of drug choices and strategies, taking into account the recipient's clinical characteristics, underlying heart failure diagnosis, immunologic risk and comorbidities seem to be the ideal approaches to improve post-transplant morbidity and survival while preventing both rejection and complications of immunosuppression. The aim of the present review is to provide a practical, comprehensive overview of contemporary immunosuppression in heart transplantation. Clinical evidence for immunosuppressive drugs is reviewed and practical approaches are provided. Cardiac allograft rejection classification and up-to-date management are summarized. Expanding therapies, such as photophoresis, are outlined. Drug-to-drug interactions of immunosuppressive agents focused on cardiovascular medications are summarized. Special situations involving heart transplantation such as sarcoidosis, Chagas diseases and pediatric immunosuppression are also reviewed. The evolution of phamacogenomics to individualize immunosuppressive therapy is described. Finally, future perspectives in the field of immunosuppression in heart transplantation are highlighted.
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Affiliation(s)
- Livia A Goldraich
- Heart Transplantation Unit, Cardiology Department, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Santiago A Tobar Leitão
- Cardiovascular Research Laboratory, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul. Porto Alegre, Brazil
| | - Fernando L Scolari
- Cardiovascular Research Laboratory, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul. Porto Alegre, Brazil
| | | | - Marcely G Bonatto
- Heart Failure Center, Heart Transplantation Program, Hospital Santa Casa de Misericórdia, Curitiba, Brazil
| | - Dipika Munyal
- Multiorgan Transplant, University Health Network, Toronto General Hospital, Toronto, Canada
| | - Jennifer Harrison
- Multiorgan Transplant, University Health Network, Toronto General Hospital, Toronto, Canada
| | - Rafaela V P Ribeiro
- Latner Thoracic Surgery Research Laboratories, Toronto General Research Institute, University Health Network, Toronto, Canada
| | - Estela Azeka
- Heart Institute (InCor-HC.FMUSP), University of Sao Paulo, Sao Paulo, Brazil
| | - Diogo Piardi
- Post-graduation Program in Medical Science: Cardiology and Cardiovascular Science, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria R Costanzo
- Heart Failure Research, Advocate Heart Institute, Medical Director, Edward Hospital Center for Advanced Heart Failure, Naperville, Illinois, United States
| | - Nadine Clausell
- Post-graduation Program in Medical Science: Cardiology and Cardiovascular Science, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Harrison JJ, Wang J, Cervenko J, Jackson L, Munyal D, Hamandi B, Chernenko S, Dorosz J, Chaparro C, Singer LG. Pilot study of a pharmaceutical care intervention in an outpatient lung transplant clinic. Clin Transplant 2012; 26:E149-57. [PMID: 22507355 DOI: 10.1111/j.1399-0012.2012.01623.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lung transplant recipients have complex drug regimens. Study objectives were to assess drug therapy problems (DTPs), pharmacist recommendations, and patient satisfaction with pharmacist services. METHODS Using a pharmaceutical care assessment process, pharmacists identified DTPs and made therapeutic recommendations. Number of DTPs identified per pharmacist visit was calculated and compared to standard care visits through retrospective chart review. Potential clinical impact of recommendations was evaluated by blinded clinicians. Patient satisfaction was assessed via survey. RESULTS Fifty-five DTPs were identified in 43 patients over 50 pharmacist visits (1.05 ± 1.34 DTPs per visit). In these same patients, rate of DTP identification was 0.51 ± 0.64 DTPs per standard visit in the preceding two-wk period (p = 0.018 vs. pharmacist visit). The most common DTPs identified by the pharmacist were adverse drug effect (27%) and untreated indication (25%). Overall, 62% of pharmacist recommendations were rated very significant or significant. Survey return rate was 58% and satisfaction scores ranged from 3 to 5 out of 5. Review of medications and teaching regarding the use of medications received the most "very satisfied" and "highly important" scores. CONCLUSIONS Pharmacists can make valuable contributions in a lung transplant clinic setting by identifying DTPs and making recommendations with a positive impact on patient outcomes and satisfaction.
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Affiliation(s)
- Jennifer J Harrison
- Department of Pharmacy Services, Toronto General Hospital, University Health Network, Toronto, ON, Canada.
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