Medication Therapy for Solid Organ Transplantation: After the Surgery

The number of transplants performed annually increased each year from 2012 to 2016. There were 33,611 solid organ transplants performed in the United States in 2016. In addition to higher rates of transplantation, one-year allograft survival has significantly improved due to advances in clinical management of solid organ transplant patients and improved immunosuppressive therapy. Adequate immunosuppression is key to patient survival. Without effective immunosuppression after transplants, the allograft would face rejection and solid organ transplant recipients would only survive weeks at the most.

Immunosuppressive therapy is divided into two phases: induction therapy and maintenance therapy. Patients are often treated with induction therapy soon after the transplant with either a lymphocyte-depleting agent or an interleukin 2 receptor antagonist to prevent acute rejection. Maintenance therapy is then given for the entirety of the recipient’s life and usually involves a calcineurin inhibitor, a mycophenolate product, and/or corticosteroids. In addition, some newer immunosuppressive agents have been shown to limit toxicities experienced by solid organ transplant recipients, while still preventing allograft rejection.

Despite the efficacy of immunosuppression agents for allograft and patient survival, they pose numerous risks to patients due to infusion reactions, side effect profiles, and effects of long-term immunosuppression. Each immunosuppressive agent requires specific monitoring parameters to prevent and control toxicities and ensure adequate immunosuppression. Pharmacists play a major role in the care provided to solid organ transplant recipients and can improve long-term patient outcomes by preventing drug interactions, performing therapeutic drug monitoring, and educating patients about side effects and complications of immunosuppressive agents.