Improvement in immunosuppression therapy monitoring in organ transplant recipients

Thrall, Stephanie; Fominaya, Cory E; Chiasson, Jordan; Castle, Sharon; Taber, David J.

doi:10.2146/ajhp160872

Cited by 7 publications

(3 citation statements)

References 25 publications

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“…The role of clinical pharmacists as part of multidisciplinary teams of solid organ transplant programmes has been discussed worldwide, as they may provide safer and more effective care to transplant recipients, and help to support maintenance of allograft function contributing to improvement in quality of care 1,2 . Importantly, the presence of a clinical pharmacist in the multidisciplinary team has become a requirement in the accreditation process of transplant centres in the United States (U.S.) 2–6 . Pharmaceutical care may be even more relevant for thoracic transplant recipients, given the greater complexity of their medication regimens 7 .…”

Section: What Is Known and Objectivementioning

confidence: 99%

Challenges for expansion of thoracic transplant clinical pharmacy in a developing country: comparison with U.S. accredited centres and call for action

Einsfeld

Hastenteufel

Taber

et al. 2021

Clinical Pharmacy Therapeu

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The role of clinical pharmacists as part of multidisciplinary teams of solid organ transplant programmes has been discussed worldwide, as they may provide safer and more effective care to transplant recipients, and help to support maintenance of allograft function contributing to improvement in quality of care. 1,2 Importantly, the presence of a clinical pharmacist in the multidisciplinary team has become a requirement in the accreditation process of transplant centres in the United States (U.S.). 2-6 Pharmaceutical care may be even more relevant for thoracic transplant recipients, given the greater complexity of their medication regimens. 7 In North America, the majority of transplant programmes have a well-defined set of activities performed by clinical pharmacists, which include interaction with other healthcare professionals, patient and caregivers education. 2

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Section: What Is Known and Objectivementioning

confidence: 99%

Challenges for expansion of thoracic transplant clinical pharmacy in a developing country: comparison with U.S. accredited centres and call for action

Einsfeld

Hastenteufel

Taber

et al. 2021

Clinical Pharmacy Therapeu

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“…One such solution, a transplant-population monitoring dashboard, was developed and implemented across several Veterans Affairs (VA) health systems, demonstrating improved monitoring of immunosuppression regimens. 15 As part of a follow-up grant, this system's functionality was expanded and tested in a multicenter, randomized clinical trial. 16 This analysis sought to address if a multicenter bioinformatics dashboard was able to accurately identify potential medication safety issues in Veteran transplant recipients.…”

Section: Introductionmentioning

confidence: 99%

A Randomized Control Trial Testing a Medication Safety Dashboard in Veteran Transplant Recipients

et al. 2023

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Introduction Medication errors, adverse events, and nonadherence in organ transplant recipients are common and can lead to suboptimal outcomes. A medication safety dashboard was developed to identify issues in medication therapy. Research Questions Can a multicenter bioinformatics dashboard accurately identify clinically relevant medication safety issues in US military Veteran transplant recipients? Design The dashboard was tested through a 24-month, prospective, cluster-randomized controlled multicenter study. Pharmacists used the dashboard to identify and address potential medication safety issues, which was compared with usual care. Results Across the 10 sites (5 control sites and 5 intervention sites), 2012 patients were enrolled (1197 intervention vs 831 control). The mean age was 65 (10) years, 95% male, and 27% Black. The dashboard produced 18 132 alerts at a rate of 0.61(0.32) alerts per patient-month, ranging from 0.44 to 0.72 across the 5 intervention sites. Lab-based issues were most common (83.4%), followed by nonadherence (9.4%) and transitions in care (6.4%); 56% of alerts were addressed, taking an average of 43 (29) days. Common responses to alerts included those already resolved by another provider (N = 4431, 44%), the alert not clinically relevant (N = 3131, 31%), scheduling of follow-up labs (N = 591, 6%), and providing medication reconciliation/education (N = 99, 1%). Inaccurate flags significantly decreased over the study by a mean of −0.6% per month (95% CI −0.1 to −1.0; P = .0265), starting at 13.4% and ending at 2.6%. Conclusion This multicenter cluster-randomized controlled trial demonstrated that a medication safety dashboard was feasibly deployable across the VA healthcare system, creating valid alerts.

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“…However, allo-CLET is associated with continuous systemic immunosuppression to prevent allograft loss ( 11 ). Unfortunately, adverse effects related to immunosuppression regimes are always present and demand closed monitoring ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

Genetic Modification of Limbal Stem Cells to Decrease Allogeneic Immune Responses

Valdivia¹,

Bertolin

Breda

et al. 2021

Front. Immunol.

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Limbal stem cell (LSC) transplantation is the only efficient treatment for patients affected by LSC deficiency (LSCD). Allogeneic LSC transplantation is one of the most successful alternative for patients with bilateral LSCD. Nevertheless, the high variability of the human leukocyte antigens (HLA) remains a relevant obstacle to long-term allogeneic graft survival. This study characterized the immunologic properties of LSCs and proposed a genetic engineering strategy to reduce the immunogenicity of LSCs and of their derivatives. Hence, LSC HLA expression was silenced using lentiviral vectors encoding for short hairpin (sh) RNAs targeting β2-microglobulin (β2M) or class II major histocompatibility complex transactivator (CIITA) to silence HLA class I and II respectively. Beside the constitutive expression of HLA class I, LSCs showed the capability to upregulate HLA class II expression under inflammatory conditions. Furthermore, LSCs demonstrated the capability to induce T-cell mediated immune responses. LSCs phenotypical and functional characteristics are not disturbed after genetic modification. However, HLA silenced LSC showed to prevent T cell activation, proliferation and cytotoxicity in comparison to fully HLA-expressing LSCs. Additionally; HLA-silenced LSCs were protected against antibody-mediated cellular-dependent cytotoxicity. Our data is a proof-of-concept of the feasibility to generate low immunogenic human LSCs without affecting their typical features. The use of low immunogenic LSCs may support for long-term survival of LSCs and their derivatives after allogeneic transplantation.

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Improvement in immunosuppression therapy monitoring in organ transplant recipients

Abstract: Clinical pharmacist intervention resulted in an increased number of patients with solid organ transplant meeting minimum immunosuppressant monitoring recommendations.

Cited by 7 publications

References 25 publications

Challenges for expansion of thoracic transplant clinical pharmacy in a developing country: comparison with U.S. accredited centres and call for action

Challenges for expansion of thoracic transplant clinical pharmacy in a developing country: comparison with U.S. accredited centres and call for action

A Randomized Control Trial Testing a Medication Safety Dashboard in Veteran Transplant Recipients

Genetic Modification of Limbal Stem Cells to Decrease Allogeneic Immune Responses

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