Long‐Term Impact of Different Immunosuppressive Drugs on QT and PR Intervals in Renal Transplant Patients

Abstract

QT interval prolongation, a marker of risk for arrhythmias and sudden death, is highly prevalent among kidney transplant patients receiving different classes of immunosuppressive drugs.

Use of isavuconazole in a patient with voriconazole‐induced QTc prolongation

“…QTc prolongation is a common and potentially life‐threatening condition in patients who undergo solid organ or hematopoietic stem cell transplantation. The reasons for this are not entirely understood, but may include perioperative QTc‐prolonging medications and electrolyte imbalances . Other well‐described risk factors for post‐transplant QTc prolongation include structural heart disease, cardiac ischemia, thyroid disease, diabetes mellitus, female gender, and heritable cardiac syndromes …”

“…Unlike other triazole antifungals, isavuconazole can shorten the QTc interval in a concentration‐dependent manner, and is contraindicated in patients with familial short QTc syndrome . Voriconazole is indicated for prophylaxis against Aspergillus species, but has a well‐described side effect of QTc interval prolongation, especially when given in combination with other QTc‐prolonging agents . We present the case of a lung transplant recipient who developed QTc prolongation while receiving voriconazole.…”

Acquired long QT syndrome in chronic kidney disease patients

“…Hyponatremia [20] Hyponatremia is related with QT prolongation. Drugs [21][22][23][24][25][26] The risk of drug-induced QTc interval prolongation varies by drug and presence of risk factors Comorbidities Cardiomyopathy; [18,19] Cardiomyopathy is a risk factor for QT prolongation. Congestive heart failure; [27,28] Patients with severe systolic HF had statistically significant prolongation of the QTc interval.…”

“…However, the QT interval was measured only after two weeks, and the effect of immunosuppressive drugs on the QT interval was not assessed [96]. In one study, QT interval prolongation was caused by immunosuppressive drugs (tacrolimus, cyclosporine A, everolimus and azathioprine) in the long-term follow-up of kidney transplant patients [23]. We summarize the drugs known to cause TdP that require dose adjustment in patients with chronic kidney disease (Table 3) [21,22,[24][25][26][97][98][99].…”

Potential drug–drug interactions associated with drugs currently proposed for COVID‐19 treatment in patients receiving other treatments

“…Co-administration with hydroxychloroquine Calcineurin inhibitors (tacrolimus and ciclosporin), as well as m-TOR inhibitors (everolimus and sirolimus), can cause QT prolongation [58]. One must check for the occurrence of rhythm disturbances if there is co-administration with hydroxychloroquine.…”