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Azadi S, Shahabinezhad F, Shafiekhani M. Drug-related Problems in Solid-Organ Transplant Recipients Hospitalized for COVID-19: An Experience of a Referral Tertiary Center in Iran. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:577-587. [PMID: 36380982 PMCID: PMC9652498 DOI: 10.30476/ijms.2022.93366.2467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/24/2021] [Accepted: 01/31/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Transplanted patients receiving immunosuppressive agents are at a higher risk of Coronavirus-disease-2019 (COVID-19), and their polypharmacy state makes the choice of treatment challenging. This study aimed to assess the drug-related problems (DRP) and clinical pharmacists' interventions to manage transplanted patients and candidates for transplantation with COVID-19. METHODS This cross-sectional study was conducted in the COVID-19 intensive care unit of Shiraz Organ Transplantation Center (Iran), from March 2020 to April 2021. Patients were admitted to the COVID-19 intensive care unit based on clinical symptoms or positive polymerase chain reaction (PCR) tests. The clinical pharmacist reviewed all medications and physicians' orders on a daily basis and evaluated DRPs in accordance with the pharmaceutical care network of Europe (PCNE) classification (V 8.01). The treatment team was informed of the DRPs, and the acceptance or rejection of the intervention was also documented. Data were analyzed using SPSS (Version 25.0). In order to determine the proportion and determinants of drug-related problems, descriptive statistics and logistic regression were applied, respectively. RESULTS A clinical pharmacist reviewed 631 individuals with 11770 medication orders, and 639 DRPs were found in 69% of them with an average of 1.01±1 per patient. The most commonly reported DRPs were treatment efficacy issues followed by adverse drug reactions (ADRs). A total of 982 interventions were provided at prescriber, patient, and drug levels, of which 801 were accepted, and 659 (82.27%) were fully implemented. CONCLUSION There have been considerable drug-related issues in managing transplanted patients with COVID-19. DRPs are more common in people with polypharmacy, more than three comorbidities, and hydroxychloroquine regimens.
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Affiliation(s)
- Soha Azadi
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farbod Shahabinezhad
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Shafiekhani
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Yılmaz EA, Özdemir Ö. Solid organ transplantations and COVID-19 disease. World J Transplant 2021; 11:503-511. [PMID: 35070786 PMCID: PMC8713305 DOI: 10.5500/wjt.v11.i12.503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/04/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
Tens of thousands of people worldwide became infected with severe acute respiratory syndrome coronavirus-2. Death rate in the general population is about 1%-6%, but this rate rises up to 15% in those with comorbidities. Recent publications showed that the clinical progression of this disease in organ recipients is more destructive, with a fatality rate of up to 14%-25%. We aimed to review the effect of the pandemic on various transplantation patients. Coronavirus disease 2019 (COVID-19) has not only interrupted the lives of waiting list patients’; it has also impacted transplantation strategies, transplant surgeries and broken donation chains. COVID-19 was directly and indirectly accountable for a 73% surplus in mortality of this population as compared to wait listed patients in earlier years. The impact of chronic immunosuppression on outcomes of COVID-19 remains unclear but understanding the immunological mechanisms related to the virus is critically important for the lifetime of transplantation and immune suppressed patients. It is hard to endorse changing anti-rejection therapy, as the existing data evaluation is not adequate to advise substituting tacrolimus with cyclosporine during severe COVID-19 disease.
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Affiliation(s)
- Emine Aylin Yılmaz
- Division of Pediatric Allergy and Immunology, Sakarya University Medical Faculty, Adapazarı 54100, Sakarya, Turkey
| | - Öner Özdemir
- Division of Pediatric Allergy and Immunology, Sakarya University Medical Faculty, Adapazarı 54100, Sakarya, Turkey
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Ra R, Kim JS, Jeong KH, Hwang HS. COVID-19 and Sirolimus Treatment in a Kidney Transplant Recipient. EXP CLIN TRANSPLANT 2021; 19:977-980. [PMID: 34545780 DOI: 10.6002/ect.2021.0232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
One year after COVID-19 was declared a pandemic, the management of the disease in kidney transplant patients remains uncertain. The interruption of immunosuppressive therapy is frequently suggested in kidney transplant recipients with COVID-19; however, such an interruption potentially increases the risk of allograft rejection and hyperimmune response. We here report the successful treatment of COVID-19 pneumonia in a kidney transplant recipient who received a sirolimus-based regimen. The course of COVID-19 management was favorable for maintaining sirolimus treatment. Nevertheless, the patient showed signs of extreme overexposure to sirolimus because of drug interaction with antiviral treatment. This case illustrates the advantages and related adverse events of sirolimus-based immunosuppression in the management of COVID-19 in kidney transplant recipients.
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Affiliation(s)
- Ri Ra
- From the Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Republic of Korea
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Ward D, Gørtz S, Ernst MT, Andersen NN, Kjær SK, Hallas J, Christensen S, Christiansen CF, Israelsen SB, Benfield T, Pottegård A, Jess T. The effect of immunosuppressants on the prognosis of SARS-CoV-2 infection. Eur Respir J 2021; 59:13993003.00769-2021. [PMID: 34475227 PMCID: PMC8435811 DOI: 10.1183/13993003.00769-2021] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/09/2021] [Indexed: 12/15/2022]
Abstract
Background Immunosuppression may worsen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We conducted a nationwide cohort study of the effect of exposure to immunosuppressants on the prognosis of SARS-CoV-2 infection in Denmark. Methods We identified all SARS-CoV-2 test-positive patients from February 2020 to October 2020 and linked healthcare data from nationwide registers, including prescriptions for the exposure (immunosuppressant drugs). We estimated relative risks of hospital admission, intensive care unit (ICU) admission and death (each studied independently up to 30 days from testing) with a log-linear binomial regression adjusted for confounders using a propensity score-based matching weights model. Results A composite immunosuppressant exposure was associated with a significantly increased risk of death (adjusted relative risk 1.56 (95% CI 1.10–2.22)). The increased risk of death was mainly driven by exposure to systemic glucocorticoids (adjusted relative risk 2.38 (95% CI 1.72–3.30)), which were also associated with an increased risk of hospital admission (adjusted relative risk 1.34 (95% CI 1.10–1.62)), but not of ICU admission (adjusted relative risk 1.76 (95% CI 0.93–3.35)); these risks were greater for high cumulative doses of glucocorticoids than for moderate doses. Exposure to selective immunosuppressants, tumour necrosis factor inhibitors or interleukin inhibitors was not associated with an increased risk of hospitalisation, ICU admission or death, nor was exposure to calcineurin inhibitors, other immunosuppressants, hydroxychloroquine or chloroquine. Conclusions Exposure to glucocorticoids was associated with increased risks of hospital admission and death. Further investigation is needed to determine the optimal management of coronavirus disease 2019 (COVID-19) in patients with pre-morbid glucocorticoid usage, specifically whether these patients require altered doses of glucocorticoids. In a nationwide cohort study of SARS-CoV-2 infections in Denmark, pre-morbid exposure to systemic glucocorticoids was associated with an increased risk of hospital admission and death, whereas other immunosuppressants were nothttps://bit.ly/3xRp7ZL
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Affiliation(s)
- Daniel Ward
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark .,Department of Clinical Medicine, Center for Molecular Prediction of Inflammatory Bowel Disease (PREDICT), Aalborg University, Copenhagen, Denmark
| | - Sanne Gørtz
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Martin Thomsen Ernst
- Department of Public Health, Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Nynne Nyboe Andersen
- Department of Medical Gastroenterology and Hepatology, Rigshospitalet, Copenhagen, Denmark
| | - Susanne K Kjær
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jesper Hallas
- Research Unit of Clinical Pharmacology, University of Southern Denmark, Odense, Denmark
| | | | | | - Simone Bastrup Israelsen
- Department of Infectious Diseases, Center of Research & Disruption of Infectious Diseases (CREDID), Copenhagen University Hospital, Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Center of Research & Disruption of Infectious Diseases (CREDID), Copenhagen University Hospital, Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Anton Pottegård
- Department of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Tine Jess
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Department of Clinical Medicine, Center for Molecular Prediction of Inflammatory Bowel Disease (PREDICT), Aalborg University, Copenhagen, Denmark
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Dashti-Khavidaki S, Moghadamnia M, Jafarian A, Chavoshi-Khamneh A, Moradi A, Ahmadinejad Z, Ghiasvand F, Tasa D, Nasiri-Toosi M, Taher M. Thrombotic Microangiopathy, Antibody-Mediated Rejection, and Posterior Reversible Leukoencephalopathy Syndrome in a Liver Transplant Recipient: Interplay Between COVID-19 and Its Treatment Modalities. EXP CLIN TRANSPLANT 2021; 19:990-993. [PMID: 34269648 DOI: 10.6002/ect.2021.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The present COVID-19 pandemic is a cause for concern among solid-organ transplant recipients, who are generally at high risk for infection and for whom infection with COVID-19 carries additional risks for complications and mortality that are higher than the COVID-19-associated risks for the general population. We report the case of a liver transplant recipient who presented with COVID-19 and multiple complications. A 39-year-old woman with a liver transplant was diagnosed with COVID-19 within the first week after transplant surgery. Mycophenolate was withheld, and interferon β was administered for management of COVID-19. She developed thrombotic thrombocytopenic purpura, acute antibody-mediated rejection, and posterior reversible leukoencephalopathy syndrome during hospitalization. All of these complications may be related to COVID-19 or its management modalities. We considered 3 possible causes for thrombotic thrombocytopenic purpura in this patient: the COVID-19 infection itself, immunosuppression treatment with cyclosporine, and treatment with interferon β. Immunosuppression reduction and interferon treatment may result in antibody-mediated rejection. COVID-19, thrombotic thrombocytopenic purpura, and cyclosporine may play a combined role in the development of posterior reversible leukoencephalopathy syndrome. In conclusion, thrombotic thrombocytopenic purpura, antibody-mediated rejection, and posterior reversible leukoencephalopathy syndrome may represent a continuum of 3 thrombotic microangiopathy conditions fostered by interplay between the COVID-19 infection and the treatment modalities for COVID-19 management in this patient.
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Affiliation(s)
- Simin Dashti-Khavidaki
- From the Department of Pharmacotherapy, Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Dale M, Sogawa H, Seyedsaadat SM, Wolf DC, Bodin R, Partiula B, Nog R, Latifi R, John D, Veillette G, Diflo T, Nishida S. Successful Management of COVID-19 Infection in 2 Early Post-Liver Transplant Recipients. Transplant Proc 2021; 53:1175-1179. [PMID: 33888342 PMCID: PMC7972672 DOI: 10.1016/j.transproceed.2021.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/13/2021] [Accepted: 03/14/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has affected all facets of life and continues to cripple nations. COVID-19 has taken the lives of more than 2.1 million people worldwide, with a global mortality rate of 2.2%. Current COVID-19 treatment options include supportive respiratory care, parenteral corticosteroids, and remdesivir. Although COVID-19 is associated with increased risk of morbidity and mortality in patients with comorbidities, the vulnerability, clinical course, optimal management, and prognosis of COVID-19 infection in patients with organ transplants has not been well described in the literature. The treatment of COVID-19 differs based on the organ(s) transplanted. Preliminary data suggested that liver transplant patients with COVID-19 did not have higher mortality rates than untransplanted COVID-19 patients. Table 1 depicts a compiled list of current published data on COVID-19 liver transplant patients. Most of these studies included both recent and old liver transplant patients. No distinction was made for early liver transplant patients who contract COVID-19 within their posttransplant hospitalization course. This potential differentiation needs to be further explored. Here, we report 2 patients who underwent liver transplantation who acquired COVID-19 during their posttransplant recovery period in the hospital. CASE DESCRIPTIONS Two patients who underwent liver transplant and contracted COVID-19 in the early posttransplant period and were treated with hydroxychloroquine, methylprednisolone, tocilizumab, and convalescent plasma. This article includes a description of their hospital course, including treatment and recovery. CONCLUSION The management of post-liver transplant patients with COVID-19 infection is complicated. Strict exposure precaution practice after organ transplantation is highly recommended. Widespread vaccination will help with prevention, but there will continue to be patients who contract COVID-19. Therefore, continued research into appropriate treatments is still relevant and critical. A temporary dose reduction of immunosuppression and continued administration of low-dose methylprednisolone, remdesivir, monoclonal antibodies, and convalescent plasma might be helpful in the management and recovery of severe COVID-19 pneumonia in post-liver transplant patients. Future studies and experiences from posttransplant patients are warranted to better delineate the clinical features and optimal management of COVID-19 infection in liver transplant recipients.
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Affiliation(s)
- Miles Dale
- General Surgery, Westchester Medical Center, Valhalla, New York.
| | - Hiroshi Sogawa
- Transplant Surgery, Westchester Medical Center, Valhalla, New York
| | | | - David C Wolf
- Liver and Gastroenterology, Westchester Medical Center, Valhalla, New York
| | - Roxana Bodin
- Liver and Gastroenterology, Westchester Medical Center, Valhalla, New York
| | - Bernard Partiula
- Liver and Gastroenterology, Westchester Medical Center, Valhalla, New York
| | - Rajat Nog
- Transplant Infectious Disease, Westchester Medical Center, Valhalla, New York
| | - Rifat Latifi
- General Surgery, Westchester Medical Center, Valhalla, New York
| | - Devon John
- Transplant Surgery, Westchester Medical Center, Valhalla, New York
| | | | - Thomas Diflo
- Transplant Surgery, Westchester Medical Center, Valhalla, New York
| | - Seigo Nishida
- Transplant Surgery, Westchester Medical Center, Valhalla, New York
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Shafiekhani M, Dehghani A, Shahisavandi M, Nabavizadeh SA, Kabiri M, Hassani AH, Haghpanah A. Pharmacotherapeutic approach toward urological medications and vaccination during COVID-19: a narrative review. Ther Adv Urol 2021; 13:17562872211046794. [PMID: 34603508 PMCID: PMC8481748 DOI: 10.1177/17562872211046794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/30/2021] [Indexed: 01/08/2023] Open
Abstract
One year after the prevalence of the novel coronavirus pandemic, some aspects of the physiopathology, treatment and progression of coronavirus 2019 disease (COVID-19) have remained unknown. Since no comprehensive study on the use of urological medications in patients with COVID-19 has been carried out, this narrative review aimed to focus on clinically important issues about the treatment of COVID-19 and urologic medications regarding efficacy, modifications, side effects and interactions in different urologic diseases. In this review, we provide information about the pharmacotherapeutic approach toward urologic medications in patients with COVID-19 infection. This study provides an overview of medications in benign prostatic hyperplasia, prostate cancer, impotence and sexual dysfunction, urolithiasis, kidney transplantation and hypertension as the most frequent diseases in which the patients are on long-term medications. Also, the effect of urologic drugs on the efficacy of vaccination is briefly discussed.
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Affiliation(s)
- Mojtaba Shafiekhani
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, IranDepartment of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Anahita Dehghani
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mina Shahisavandi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Maryam Kabiri
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Abdolreza Haghpanah
- Assistant Professor of Urology, Endourology Ward, Urology Department, Shiraz University of Medical Sciences, Shiraz, 71348-44119, Iran Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, 71348-44119, Iran
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