Immunosuppressive Medication and Non-Rejection-Related Complications Following Heart Transplantation

Abstract

<jats:title>Abstract</jats:title><jats:p><jats:bold>Background:</jats:bold> Although the clinical evolution of a patient with heart failure is initially improved by transplantation, a number of potential complications may occur in the post-transplant period, which may be directly related to the effects of chronic immunosuppression. The purpose of this study was to analyze the occurrence and frequency of post-transplant complications related to immunosuppressive treatment in the Institute of Cardiovascular Diseases and Transplantation of Târgu Mureș, Romania.</jats:p><jats:p><jats:bold>Material and methods:</jats:bold> This is a descriptive study including 53 patients out of a total of 71 patients who underwent cardiac transplantation between 2000 and 2017 in the Institute of Cardiovascular Disease and Cardiac Transplantation in Târgu Mureș, Romania. Data were collected from the patient files and included demographic, clinical and laboratory data, as well as information about post-transplant complications related to immunosuppressive treatment.</jats:p><jats:p><jats:bold>Results:</jats:bold> The mean age of patients undergoing heart transplantation was 40.72 ± 14.07 years, the majority of patients being male (84.91%) and living in an urban environment (56.60%). The average length of hospital stay was 33.6 days. From the total number of patients, 7 (13.2%) presented post-transplantation bacterial infections, while antibodies indicating the presence or history of B hepatitis, toxoplasma, and cytomegalovirus infection were identified with a relatively high incidence in the study population.</jats:p><jats:p><jats:bold>Conclusions:</jats:bold> Infections following surgery are probably the most common post-transplant pathology, the primary reason being the administration of immunosuppressive medication.</jats:p>

Prevention and Rehabilitation After Heart Transplantation: A Clinical Consensus Statement of the European Association of Preventive Cardiology, Heart Failure Association of the ESC, and the European Cardio Thoracic Transplant Association, a Section of ESOT

“…Some of these IS-related complications, such as dyslipidaemia or osteoporosis, could be prevented, and some, such as tremor and leukopenia, can be managed by modifying the doses of the IS agents. Other adverse effects require prescription of new therapies (to address infections, endocrine abnormalities, neurological complica-tions, nephropathy and arterial hypertension [AH]) [6,[51][52][53]. Guide-lines for addressing the complications of IS therapy include regular screening for adverse events, minimizing drug doses, drug substi-tution, and drug withdrawal if possible, as well as initiating targeted therapies for a specific complication [54,55].…”

“…Mycophenolate mofetil and azathioprine have not been shown to have a large impact on insulin action or glu-cose metabolism and so do not appear to have a major role in PTDM. There is however increasing evidence that the commonly used IS agents, particularly calcineurin inhibitors (CNIs; tacrolimus, cyclosporine) and inhibitors of the mammalian target of rapamycin (mTOR; sirolimus and everolimus), may contribute to PTDM [ 53 ]. A major modifiable risk factor for the development of PTDM is IS therapy, but risk versus benefit analysis is needed to balance the risk of developing PTDM versus the risk of rejection.…”