Clinical and immunological characteristics of transplant recipients with recurrent acute rejection episodes

Jacobs, U.; Blaufuβ, A.; Klehr, H. U.

doi:10.1016/s0041-1345(96)00056-5

Cited by 3 publications

(5 citation statements)

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“…in the differential diagnosis of rejection and GvHD [ 119 ], and in the assessment of the therapeutic effect in the course of initiated antiviral treatment. With the additional use of this tool and the early initiation of virustatic therapy, we were able to rule out any CMV-related acute or long-term kidney transplant injuries in the pre-valganciclovir prophylaxis era as early as 1992, resulting in a consecutive two-year transplant survival rate of 100% [ 119 , 120 , 121 ]. It remains to be seen whether valganciclovir prophylaxis might be more harmful in terms of its nephrotoxic potency than its prophylactic indication.…”

Section: Resultsmentioning

confidence: 99%

“…11. Severe night sweats may be an early indicator of CMV disease and need to be reported immediately [ 120 , 121 ]. Patient empowerment through appropriate information can be a valuable contribution to risk prevention.…”

Section: Resultsmentioning

confidence: 99%

“…IPM requires a holistic clinical view of the patient's entire medication regimen. The educational background of the designing and performing IPM internist with advanced education in clinical pharmacology also covers a broad spectrum of expertise and successful engagement in improving outcomes in clinical transplantation [119][120][121][176][177][178][179][180][181][182][183][184][185] and the qualification as Distinguished Educator of the Transplantation Society Academy, thus ensuring experience in a broad professional transplantation context. In addition to 21 years of daily experience in TDM of immunosuppressants in transplantation, this allows a highly patient-individualized focus for a comprehensive evaluation.…”

Section: Strengths and Weaknessesmentioning

confidence: 99%

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A Drug Safety Briefing (II) in Transplantation from Real-World Individual Pharmacotherapy Management to Prevent Patient and Graft from Polypharmacy Risks at the Very Earliest Stage

Wolf

2024

Pharmaceuticals

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For early and long-term patient and graft survival, drug therapy in solid organ and hematopoietic stem cell transplantation inevitably involves polypharmacy in patients with widely varying and even abruptly changing conditions. In this second part, relevant medication briefing is provided, in addition to the scores defined in the previously published first part on the design of the Individual Pharmacotherapy Management (IPM). The focus is on the growing spectrum of contemporary polypharmacy in transplant patients, including early and long-term follow-up medications. 1. Unlike the available drug–drug interaction (DDI) tables, for the first time, this methodological all-in-one device refers to the entire risks, including contraindications, special warnings, adverse drug reactions (ADRs), and DDIs. The selection of 65 common critical drugs results from 10 years of daily IPM with real-world evidence from more than 60,800 IPM inpatient and outpatient medication analyses. It includes immunosuppressants and typical critical antimicrobials, analgesics, antihypertensives, oral anticoagulants, antiarrhythmics, antilipids, antidepressants, antipsychotics, antipropulsives, antiemetics, propulsives, proton pump inhibitors (PPIs), sedatives, antineoplastics, and protein kinase inhibitors. As a guide for the attending physician, the drug-related risks are presented in an alphabetical overview based on the Summaries of Product Characteristics (SmPCs) and the literature. 2. Further briefing refers to own proven clinical measures to manage unavoidable drug-related high-risk situations. Drug-induced injuries to the vulnerable graft and the immunosuppressed comorbid patient require such standardized, intensive IPM and the comprehensive preventive briefing toolset to optimize the outcomes in the polypharmacy setting.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Strengths and Weaknessesmentioning

confidence: 99%

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A Drug Safety Briefing (II) in Transplantation from Real-World Individual Pharmacotherapy Management to Prevent Patient and Graft from Polypharmacy Risks at the Very Earliest Stage

Wolf

2024

Pharmaceuticals

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“…IPM-based TDM assessment requires a holistic view of the patient and a comprehensive medication analysis, both of which impact the exposure of calcineurin inhibitors. The educational background of the designing and performing internist, who has advanced education in clinical pharmacology, further covers a broad range of expertise and successful engagement in improving outcomes in clinical transplantation [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51], along with the Transplantation Society Academy Distinguished Educator qualification, all of which provide experience and the necessary professional legitimacy to relate a TDM value for an immunosuppressant to the clinical condition of the patient and to the transplant itself in a broad professional context. It enables skilled individual focus and trained placement of each TDM value in its overall environmental setting for a comprehensive assessment, alongside 21 years of daily experience in TDM for immunosuppressants in transplantation.…”

Section: Strengths and Weaknessesmentioning

confidence: 99%

A Drug Safety Concept (I) to Avoid Polypharmacy Risks in Transplantation by Individual Pharmacotherapy Management in Therapeutic Drug Monitoring of Immunosuppressants

Wolf

2023

Pharmaceutics

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For several, also vital medications, such as immunosuppressants in solid organ and hematopoietic stem cell transplantation, therapeutic drug monitoring (TDM) remains the only strategy for fine-tuning the dosage to the individual patient. Especially in severe clinical complications, the intraindividual condition of the patient changes abruptly, and in addition, drug-drug interactions (DDIs) can significantly impact exposure, due to concomitant medication alterations. Therefore, a single TDM value can hardly be the sole basis for optimal timely dose adjustment. Moreover, every intraindividually varying situation that affects the drug exposure needs synoptic consideration for the earliest adjustment. To place the TDM value in the context of the patient’s most detailed current condition and concomitant medications, the Individual Pharmacotherapy Management (IPM) was implemented in the posttransplant TDM of calcineurin inhibitors assessed by the in-house laboratory. The first strategic pillar are the defined patient scores from the electronic patient record. In this synopsis, the Summaries of Product Characteristics (SmPCs) of each drug from the updated medication list are reconciled for contraindication, dosing, adverse drug reactions (ADRs), and DDIs, accounting for defined medication scores as a second pillar. In parallel, IPM documents the resulting review of each TDM value chronologically in a separate electronic Excel file throughout each patient’s transplant course. This longitudinal overview provides a further source of information at a glance. Thus, the applied two-arm concept of TDM and IPM ensures an individually tailored immunosuppression in the severely susceptible early phase of transplantation through digital interdisciplinary networking, with instructive and educative recommendations to the attending physicians in real-time. This concept of contextualizing a TDM value to the precise patient’s condition and comedication was established at Halle University Hospital to ensure patient, graft, and drug safety.

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“…Different key players of the rejection process (T-cells, monocytes, cytokines, chemokines, cell surface molecules, such as MHC class I and II molecules and costimulatory molecules as well as anti-allograft antibodies) have been determined in experimental animal models and at least partially confirmed in human renal allograft rejection [23 -26]. With recurrent rejection episodes, the frequency of patients with younger age and anti-HLA antibodies is higher than in patients with one acute rejection [27].…”

Section: Classifications Of Renal Allograft Rejectionmentioning

confidence: 99%

Abstracts 146–159

Greger¹,

Kühn²

1999

Kidney Blood Press Res

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Clinical and immunological characteristics of transplant recipients with recurrent acute rejection episodes

Cited by 3 publications

References 0 publications

A Drug Safety Briefing (II) in Transplantation from Real-World Individual Pharmacotherapy Management to Prevent Patient and Graft from Polypharmacy Risks at the Very Earliest Stage

A Drug Safety Briefing (II) in Transplantation from Real-World Individual Pharmacotherapy Management to Prevent Patient and Graft from Polypharmacy Risks at the Very Earliest Stage

A Drug Safety Concept (I) to Avoid Polypharmacy Risks in Transplantation by Individual Pharmacotherapy Management in Therapeutic Drug Monitoring of Immunosuppressants

Abstracts 146–159

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