Monitoring heart transplant recipients in order to investigate immunosuppressive drug absorption using pharmacokinetics parameters and its’ correlation with nephrotoxicity

Zahra Tolou-Ghamari, Mohsen MirMohammad Sadeghi, Hamid Mazdak

Abstract


An appreciated and well-recognized treatment option for end stage heart failure verified as heart transplantation. Life-long immunosuppression suggested to be necessary due to the risk associated to rejection of transplanted heart by the recipient’s body. This study aimed to monitor heart transplant recipients in terms of immunosuppressive drug absorption using pharmacokinetics parameters and its’ correlation with nephrotoxicity. Heart transplanted recipients at Chamran Hospital Isfahan, Iran was studied. All data and factors that could affect immunosuppressive pharmacotherapy were noted in Excel and analyzed by SPSS. There were 10 heart transplanted patients from 24 November 2013 to 24 August 2018. Study population was comprised of 8 male and 2 female, with a minimum of 24 and a maximum of 54 years, the mean age ± SD was 38.7 ± 10.8 years old. Available data related to the hospital stay showed a minimum of 10, a maximum of 56 and a mean of 31 ± 14.9 days. Pharmacotherapy was based on cyclosporine, mycophenolate, acyclovir, prednisolone, valsartan, pantoprazole and others. Higher risk of infectious complications and malignancies after heart transplantation and a lower risk for acute or chronic rejection could be achieved by monitoring immunosuppressive drugs associated to nephrotoxicity or neurotoxicity based on well-structured program. Further studies in this direction seem to be advantageous


Keywords


Heart, Transplant; Isfahan; Pharmacotherapy; Rejection

Full Text:

PDF

References


Tolou-Ghamari Z, Palizban AA, Tredger JM. Clinical monitoring of tacrolimus after liver transplantation using pentamer formation assay and microparticle enzyme immunoassay. Drugs in R&D. Volume 5:17-22, 2004.

Asleh R, Snipelisky D, Hathcock M, Kremers W, Liu D, Batzler A, Jenkins G, Kushwaha S, Pereira N. Genome wide association study reveals novel genetic loci associated with change in renal function in heart transplant recipients. Clin Transplant 30:e13395, 2018.

Marino J, Babiker-Mohamed MH, Crosby-Bertorini P, Paster JT, LeGuern C, Germana S, Abdi R, Uehara M, Kim JI, Markmann JF, Tocco G, Benichou G. Donor exosomes rather than passenger leukocytes initiate alloreactive T cell responses after transplantation. Sci Immunol 1:aaf8759, 2016.

Reichart D, Reichenspurner H, Barten MJ. Renal protection strategies after heart transplantation. Clin Transplant 32: doi: 10.1111/ctr.13157, 2018.

Mazdak H, Tolou_Ghamari Z. Preliminary study of prevalence for bladder cancer in Isfahan Province, Iran. Arab J Urol 16:206-210, 2018.

Tolou Ghamari Z. Prevalence of lung cancer in

Isfahan province. J Egypt Natl Cancer Inst 30:57-59, 2018.

Tadayon F, Shariati A, Tolou-Ghamari Z. Study of 2550 donor-recipient demographic characteristics associated with kidney transplantation in Isfahan Province,

Iran. Am J Exp Clin Res 5:310-313, 2018.

Black CK, Termanini KM, Aguirre O, Hawksworth JS, Sosin M. Solid organ transplantation in the 21st century. Ann Transl Med 6: 409, 2018.

Jia X, Xu Meng, Yan Li, Xu C, Zeng W, Jiao Y, Han W. Optimal sampling time-point for cyclosporin A concentration monitoring in heart transplant recipients. Exp Ther Med 16:4265-4270, 2018.

Cantarovich M, Barkun J, Giannetti N, Cecere R, Besner JG, Tchervenkov J. History of C2 monitoring in heart and liver transplant patients treated with cyclosporine microemulsion. Transplant Proc 36:442S-447S, 2004.

Oellerich M, Armstrong VW. Two-hour cyclosporine concentration determination: An appropriate tool to monitor neoral therapy? Ther Drug Monit 24:40-46, 2002.

Levy GA. C2 monitoring strategy for optimising cyclosporin immunosuppression from the Neoral formulation. BioDrugs 15:279-290, 2001.

Delgado DH, Rao V, Hamel J, Miriuka S, Cusimano RJ, Ross HJ. Monitoring of cyclosporine 2-hour post-dose levels in heart transplantation: Improvement in clinical outcomes. J Heart Lung Transplant 24:1343-1346, 2005.

Balram C, Sivathasan C, Cheung YB, Tan SB, Tan YS. A limited sampling strategy for the estimation of 12-hour Neoral systemic drug exposure in heart transplant recipients. J Heart Lung Transplant 21:1016-1021, 2002.

Jorga A, Holt DW, Johnston A. Therapeutic drug monitoring of cyclosporine. Transplant Proc 36:396S-403S, 2004.

Lund LH, Edwards LB, Kucheryavaya AY, Benden C, Dipchand AI, Goldfarb S, Levvey BJ, Meiser B, Rossano JW, Yusen RD, Stehlik J. The Registry of the International Society for Heart and Lung Transplantation: Thirty-second official adult heart transplantation report-2015; Focus Theme: Early graft failure. J Heart Lung Transplant 34:124-154, 2015.

Agarwal S, Parashar A, Kapadia SR, Tuzcu EM, Modi D, Starling RC, Oliveira GH. Long-term mortality after cardiac allograft vasculopathy implications of percutaneous intervention. JACC: Heart Failure 2:281-288, 2014.

Barnard CN. The operation. A human cardiac transplant: An interim report of a successful operation performed at Groote Schuur Hospital, Cape Town. S Afr Med J 41:1271-1274, 1967.

Blanche C, Blanche DA, Kearney B, Sandhu M, Czer LS, Kamlot A, Hickey A, Trento A. Heart transplan-tation in patients seventy years of age and older: A com-parative analysis of outcome. J Thorac Cardiovasc Surg 121:532-541, 2001.

Tjang YS, van der Heijden G, Tenderich G, Körfer R, Grobbee DE. Impact of recipient's age on heart transplantation outcome. Ann Thorac Surg 85:2051-5, 2008.


Refbacks

  • There are currently no refbacks.