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  • 1
    Online Resource
    Online Resource
    Evaluating Patient-Level Medication Regimen Complexity Over Time in Heart Transplant Recipients
    SAGE Publications ; 2016
    In:  Annals of Pharmacotherapy Vol. 50, No. 11 ( 2016-11), p. 926-934
    Details
    In: Annals of Pharmacotherapy, SAGE Publications, Vol. 50, No. 11 ( 2016-11), p. 926-934
    Abstract: Background: Medication regimen complexity describes multiple characteristics of a patient’s prescribed drug regimen. Heart transplant recipients must comply with a lifelong regimen that consists of numerous medications. However, a systematic assessment of medication regimen complexity over time has not been conducted in this, or any other, transplant population. Objective: The objective of this study was to quantify patient-level medication regimen complexity over time following primary heart transplantation and heart retransplantation, using the validated patient-level Medication Regimen Complexity Index (pMRCI) tool. Methods: Medication lists were reviewed at transplant discharge and years 1, 3, and 5 post–primary heart transplant, and at transplant discharge and years 1 and 3 post–heart retransplantation. Medications were categorized as transplant-specific, other prescription, and over-the-counter (OTC). Results: In primary heart transplant recipients (n = 60), mean total medication count was 14.3 ± 3.4 at transplant discharge and did not change significantly over time ( P = 0.64). Transplant-specific medication count decreased significantly from discharge (2.9 ± 0.4) to year 5 (2.3 ± 0.6); P = 0.02. However, 32% of patients were taking 16 or more total medications at year 5 posttransplant. More than 70% of the pMRCI score was attributed to other prescription and OTC medications, which was largely driven by dosing frequency in this cohort. Medication complexity did not differ significantly between heart retransplant recipients (n = 11) and matched primary heart transplant controls (n = 22). Conclusion: Together, these data highlight the substantial medication burden after heart transplantation and reveal opportunities to address medication regimen complexity in this, and other, transplant populations.
    Type of Medium: Online Resource
    ISSN: 1060-0280 , 1542-6270
    URL: Article
    DOI: 10.1177/1060028016657552
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
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    SSG: 15,3
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  • 2
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    Perioperative Management of Cardiac Transplant Recipients Undergoing Noncardiac Surgery: Unique Challenges Created by Advancements in Care
    SAGE Publications ; 2017
    In:  Seminars in Cardiothoracic and Vascular Anesthesia Vol. 21, No. 3 ( 2017-09), p. 235-244
    Details
    In: Seminars in Cardiothoracic and Vascular Anesthesia, SAGE Publications, Vol. 21, No. 3 ( 2017-09), p. 235-244
    Abstract: Advancements in postcardiac transplant care have resulted in significant reductions in morbidity and increased life expectancy for cardiac transplant recipients. Consequently, many cardiac transplant recipients are living long enough to require subsequent noncardiac surgery. The perioperative care of heart transplant recipients presents a unique challenge as many of the common preoperative risk assessments do not apply to a transplanted heart, immunosuppressive medications have side effects and potential for drug-drug interactions, and the denervated heart results in an altered autonomic physiology and response to medications. Further adding to the challenge is that many of these noncardiac surgeries need to be performed urgently at nontransplant centers that may not be familiar with the care of these patients. This review aims to summarize the current data regarding preoperative assessment, perioperative immunosuppression management, intraoperative and anesthetic considerations, and outcomes of cardiac transplant recipients undergoing noncardiac surgery.
    Type of Medium: Online Resource
    ISSN: 1089-2532 , 1940-5596
    URL: Article
    DOI: 10.1177/1089253217706164
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2233047-1
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  • 3
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    Bariatric Surgery Is Associated With Decreased Calcineurin Inhibitor Time in Therapeutic Range After Heart Transplantation
    Elsevier BV ; 2021
    In:  Transplantation Proceedings Vol. 53, No. 2 ( 2021-03), p. 681-685
    Details
    In: Transplantation Proceedings, Elsevier BV, Vol. 53, No. 2 ( 2021-03), p. 681-685
    Type of Medium: Online Resource
    ISSN: 0041-1345
    URL: Article
    DOI: 10.1016/j.transproceed.2021.01.020
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 1500785-6
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  • 4
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    Online Resource
    Data_Sheet_1.docx
    Frontiers Media SA ; 2021
    In:  Frontiers in Genetics Vol. 12 ( 2021-4-1)
    Details
    In: Frontiers in Genetics, Frontiers Media SA, Vol. 12 ( 2021-4-1)
    Abstract: Background : The goal of the study was to assess the relationship between single nucleotide variants (SNVs) in calcineurin inhibitor (CNI) pharmacokinetic and pharmacodynamic genes and renal dysfunction in adult heart transplant (HTx) recipients. Methods : This retrospective analysis included N = 192 patients receiving a CNI at 1-year post-HTx. Using a candidate gene approach, 93 SNVs in eight pharmacokinetic and 35 pharmacodynamic genes were chosen for investigation. The primary outcome was renal dysfunction 1-year after HTx, defined as an estimated glomerular filtration rate (eGFR) & lt;45 ml/min/1.73m 2 . Results: Renal dysfunction was present in 28.6% of patients 1-year after HTx. Two SNVs [transforming growth factor beta 1 ( TGFB1 ) rs4803455 C & gt; A and phospholipase C beta 1 ( PLCB1 ) rs170549 G & gt; A] were significantly associated with renal dysfunction after accounting for a false discovery rate (FDR) of 20%. In a multiple-SNV adjusted model, variant A allele carriers of TGFB1 rs4803455 had lower odds of renal dysfunction compared to C/C homozygotes [odds ratio (OR) 0.28, 95% CI 0.12–0.62; p = 0.002], whereas PLCB1 rs170549 variant A allele carriers had higher odds of the primary outcome vs. patients with the G/G genotype (OR 2.66, 95% CI 1.21–5.84, p = 0.015). Conclusion : Our data suggest that genetic variation in TGFB1 and PLCB1 may contribute to the occurrence of renal dysfunction in HTx recipients receiving CNIs. Pharmacogenetic markers, such as TGFB1 rs4803455 and PLCB1 rs170549, could help identify patients at increased risk of CNI-associated renal dysfunction following HTx, potentially allowing clinicians to provide more precise and personalized care to this population.
    Type of Medium: Online Resource
    ISSN: 1664-8021
    URL: Article
    URL: Article
    DOI: 10.3389/fgene.2021.658983
    DOI: 10.3389/fgene.2021.658983.s001
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2021
    detail.hit.zdb_id: 2606823-0
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  • 5
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    Online Resource
    Relationship between nocturnal blood pressure patterns and end organ damage and diastolic dysfunction in heart transplant recipients
    Wiley ; 2020
    In:  Clinical Transplantation Vol. 34, No. 5 ( 2020-05)
    Details
    In: Clinical Transplantation, Wiley, Vol. 34, No. 5 ( 2020-05)
    Abstract: We assessed the relationship between circadian blood pressure (BP) patterns and clinical outcomes in a contemporary cohort of adult heart transplant recipients. Methods This retrospective, cross‐sectional study included adult heart transplant recipients at least 6 months post‐transplant. Ambulatory BP measurements were recorded over 24 hours. Nondippers were defined as a decline in average nighttime BP ≤ 10% compared with daytime. Primary outcomes were the presence of end organ damage, that is, microalbuminuria, chronic kidney disease, and/or left ventricular hypertrophy. Secondary outcomes were measures of diastolic dysfunction (ie, mitral valve deceleration time, e/e′, E/A, and isovolumetric relaxation time), microalbumin/creatinine ratio, eGFR, interventricular septal thickness, and left ventricular posterior wall thickness. Results Of 30 patients, 53.3% (n = 16) were systolic nondippers and 40% (n = 12) were diastolic nondippers. Diastolic nondippers had three times higher urine microalbumin/creatinine ratios than diastolic dippers ( P  = .03). Systolic nondippers had 16.3% lower mitral valve deceleration time ( P  = .05) than systolic dippers, while diastolic nondippers had 20.4% higher e/e′ ( P  = .05) than diastolic dippers. There were no significant relationships between BP dipping status and any of the primary outcomes. Conclusions These data suggest that systolic and diastolic nondipping BP patterns are associated with subclinical kidney damage and diastolic dysfunction in heart transplant recipients.
    Type of Medium: Online Resource
    ISSN: 0902-0063 , 1399-0012
    URL: Issue
    URL: Article
    DOI: 10.1111/ctr.v34.5
    DOI: 10.1111/ctr.13842
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2739458-X
    detail.hit.zdb_id: 2004801-4
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  • 6
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    CYP 3A pharmacogenetics and tacrolimus disposition in adult heart transplant recipients
    Wiley ; 2016
    In:  Clinical Transplantation Vol. 30, No. 9 ( 2016-09), p. 1074-1081
    Details
    In: Clinical Transplantation, Wiley, Vol. 30, No. 9 ( 2016-09), p. 1074-1081
    Abstract: Cytochrome P450 ( CYP ) 3A polymorphisms are associated with variable CYP 3A metabolizing enzyme activity and tacrolimus pharmacokinetics. We sought to determine the singular and combined impact of CYP 3A4*22 and CYP 3A5*3 variants on tacrolimus drug disposition in adult heart transplant recipients. Methods The retrospective study included 76 patients greater than one year post‐heart transplant and receiving tacrolimus. Patients were genotyped for CYP 3A4*22 and CYP 3A5*3 , and combined genotypes were classified as follows: extensive metabolizers ( EM , CYP 3A4*1/*1 + CYP 3A5*1 carriers), intermediate metabolizers ( IM , CYP 3A4*1/*1 + CYP 3A5*3/*3 , or CYP 3A4*22 carriers+ CYP 3A5*1 carriers), and poor metabolizers ( PM , CYP 3A4*22 carriers+ CYP 3A5*3/*3 ). The primary outcome was tacrolimus dose‐adjusted trough concentration (C 0 /D, ng/ mL per mg/d). Results In singular analysis, tacrolimus C 0 /D did not differ significantly between CYP 3A4*22 genotype groups. However, tacrolimus C 0 /D was 1.8‐fold lower ( P 〈 .001) in CYP 3A5 expressers vs non‐expressers. When combined CYP 3A genotypes were evaluated, tacrolimus C 0 /D was 1.8‐fold lower in EM s vs IM s ( P 〈 .001) and EM s vs PM s ( P =.001). Tacrolimus C 0 /D did not differ significantly between CYP 3A IM s vs PM s. Conclusion Combined CYP 3A genotype was associated with tacrolimus drug disposition in adult heart transplant recipients, but the effect was largely driven by CYP 3A5*3 . These data suggest that CYP 3A4*22 and combined CYP 3A genotypes are unlikely to provide additional information beyond CYP 3A5 genotype.
    Type of Medium: Online Resource
    ISSN: 0902-0063 , 1399-0012
    URL: Issue
    URL: Article
    DOI: 10.1111/ctr.2016.30.issue-9
    DOI: 10.1111/ctr.12790
    Language: English
    Publisher: Wiley
    Publication Date: 2016
    detail.hit.zdb_id: 2739458-X
    detail.hit.zdb_id: 2004801-4
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  • 7
    Online Resource
    Online Resource
    3157 Relationship between abnormal nocturnal blood pressure patterns and end-organ damage following heart transplantation.
    Cambridge University Press (CUP) ; 2019
    In:  Journal of Clinical and Translational Science Vol. 3, No. s1 ( 2019-03), p. 52-52
    Details
    In: Journal of Clinical and Translational Science, Cambridge University Press (CUP), Vol. 3, No. s1 ( 2019-03), p. 52-52
    Abstract: OBJECTIVES/SPECIFIC AIMS: Heart transplant (HTx) recipients are more likely to exhibit abnormal circadian blood pressure (BP) patterns (e.g., lack of nocturnal dip in BP) compared with the general population. Our goal was to assess the relationship between abnormal circadian BP patterns and end-organ damage in HTx recipients. METHODS/STUDY POPULATION: The retrospective study included 30 patients who were ≥ 6 months post-heart transplant and had 24-hour ambulatory BP data collected during a parent study. Nocturnal BP decline was categorized as: ≥10% decline, dipper; 〈 10% decline, non-dipper. The primary end-organ damage outcomes we plan to analyze are left ventricular hypertrophy (LVH), chronic kidney disease (CKD), and proteinuria. The association between nocturnal BP decline and the primary outcomes will be analyzed using logistic regression. RESULTS/ANTICIPATED RESULTS: The study cohort consists of 83% men and 83% Caucasians (mean age=57±14 years; mean time post-transplant =9.0±6.6 years). Systolic and diastolic non-dippers represent 53.3% and 40% of the cohort, respectively. Data are currently being analyzed for the association between nocturnal BP dipping status and LVH, CKD, and proteinuria. These findings will be presented at the conference. DISCUSSION/SIGNIFICANCE OF IMPACT: An understanding of factors, such as abnormal circadian BP patterns, that contribute to the development of end-organ damage following HTx may provide opportunities to improve BP management and prevent adverse complications in this high-risk population.
    Type of Medium: Online Resource
    ISSN: 2059-8661
    URL: Article
    DOI: 10.1017/cts.2019.124
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2898186-8
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  • 8
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    Online Resource
    Variants in mycophenolate and CMV antiviral drug pharmacokinetic and pharmacodynamic genes and leukopenia in heart transplant recipients
    Elsevier BV ; 2021
    In:  The Journal of Heart and Lung Transplantation Vol. 40, No. 9 ( 2021-09), p. 917-925
    Details
    In: The Journal of Heart and Lung Transplantation, Elsevier BV, Vol. 40, No. 9 ( 2021-09), p. 917-925
    Type of Medium: Online Resource
    ISSN: 1053-2498
    URL: Article
    DOI: 10.1016/j.healun.2021.05.020
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
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