1
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Hedvat J, Lange NW, Scheffert JL, Pereira MR, Salerno DM. Managing the significant drug-drug interaction between isavuconazole and tacrolimus in solid organ transplant recipients. Clin Transplant 2024; 38:e15278. [PMID: 38501290 DOI: 10.1111/ctr.15278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/08/2024] [Accepted: 02/19/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Jessica Hedvat
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York City, New York, USA
| | - Nicholas W Lange
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York City, New York, USA
| | - Jenna L Scheffert
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York City, New York, USA
| | - Marcus R Pereira
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| | - David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York City, New York, USA
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2
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Lange NW, King K, Husain SA, Salerno DM, Tsapepas DS, Hedvat J, Yu M, Mohan S. Obesity is associated with a higher incidence of rejection in patients on belatacept: A pooled analysis from the BENEFIT/BENEFIT-EXT clinical trials. Am J Transplant 2024:S1600-6135(24)00157-6. [PMID: 38387620 DOI: 10.1016/j.ajt.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/25/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024]
Abstract
Though belatacept is administered with a weight-based dosing schema, there has been higher clearance reported in obese patients. Therefore, we evaluated the association between body mass index (BMI) and transplant outcomes in kidney transplant recipients who were randomized to cyclosporine- or belatacept-based immunosuppression in the BENEFIT and BENEFIT-EXT randomized clinical trials. A total of 666 and 543 patients underwent randomization and transplantation in BENEFIT and BENEFIT-EXT, respectively, of which 1056 had complete data and were included in this analysis. Patients were grouped categorically according to BMI: <25, 25 to <30, and ≥30 kg/m2. BMI did influence both the incidence and severity of acute rejection. Obese patients with BMI >30 kg/m2 in the low intensity belatacept group experienced significantly more rejection at 12 months than did patients with BMI <25 kg/m2 or BMI 25 to <30 kg/m2. In both the moderate intensity belatacept and low intensity belatacept groups, obese patients with BMI >30 kg/m2 experienced significantly more severe acute rejection than did patients with BMI < 25 kg/m2 or BMI 25 to <30 kg/m2. These results suggest that obese kidney transplant recipients are at an increased risk for acute rejection when under belatacept-based immunosuppression when compared to nonobese patients.
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Affiliation(s)
- Nicholas W Lange
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA.
| | - Kristen King
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA; Columbia University Renal Epidemiology Group, New York, New York, USA
| | - Syed Ali Husain
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA; Columbia University Renal Epidemiology Group, New York, New York, USA
| | - David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Demetra S Tsapepas
- Columbia University Renal Epidemiology Group, New York, New York, USA; Division of Transplantation, Department of Surgery, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA; Department of Quality, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jessica Hedvat
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Miko Yu
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA; Columbia University Renal Epidemiology Group, New York, New York, USA
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA; Columbia University Renal Epidemiology Group, New York, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
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3
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Sabatino DC, Hedvat J, Salerno DM, Pereira MR, Lange NW. Real world experience with Maribavir for the treatment of cytomegalovirus in solid organ transplant recipients. Clin Transplant 2023; 37:e14929. [PMID: 36740886 DOI: 10.1111/ctr.14929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/14/2022] [Accepted: 02/02/2023] [Indexed: 02/07/2023]
Affiliation(s)
- David C Sabatino
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, New York, USA
| | - Jessica Hedvat
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, New York, USA
| | - David M Salerno
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, New York, USA
| | - Marcus R Pereira
- Columbia University Vagelos College of Physicians and Surgeons, Department of Medicine, New York, New York, USA
| | - Nicholas W Lange
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, New York, USA
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4
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Hedvat J, Lange NW, Salerno DM, DeFilippis EM, Kovac D, Corbo H, Chen JK, Choe JY, Lee JH, Anamisis A, Jennings DL, Codispodo G, Shertel T, Brown RS, Pereira MR. COVID-19 therapeutics and outcomes among solid organ transplant recipients during the Omicron BA.1 era. Am J Transplant 2022; 22:2682-2688. [PMID: 35801839 PMCID: PMC9349644 DOI: 10.1111/ajt.17140] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 01/25/2023]
Abstract
Treatment outcomes associated with the use of novel COVID-19 therapeutics in solid organ transplant recipients (SOTR) are not well described in the literature. The objective of this analysis was to characterize 30-day hospitalization and other key secondary endpoints experienced by outpatient SOTR with mild-moderate COVID-19 treated with nirmatrelvir/ritonavir (NR), sotrovimab, or no SARS-CoV-2 specific treatment. This IRB-approved, retrospective study included 154 SOTR with a documented positive SARS-CoV-2 infection between December 16, 2021 and January 19, 2022 (a predominant Omicron BA.1 period in New York City). Patients who received NR (N = 28) or sotrovimab (N = 51) experienced a lower rate of 30-day hospitalization or death as compared to those who received no specific treatment (N = 75) (p = .009). A total of three deaths occurred, all among patients who initially received no specific treatment prior to hospitalization. These results suggest a role for SARS-CoV-2 specific agents in the treatment of SOTR with COVID-19, and that there does not appear to be any difference in effectiveness when comparing NR versus sotrovimab.
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Key Words
- aki, acute kidney injury
- arr, adjusted risk ratio
- bmi, body mass index
- ci, confidence interval
- eua, emergency use authorization
- fda, food and drug administration
- iqr, interquartile range
- mmf, mycophenolate mofetil
- nr, nirmatrelvir/ritonavir
- nyph, newyork-presbyterian hospital
- rrr, relative risk reduction
- scr, serum creatinine
- sotr, solid organ transplant recipient
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Affiliation(s)
- Jessica Hedvat
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA,Jessica Hedvat, Department of Pharmacy, NewYork-Presbyterian Hospital, New York City, NY, USA.
| | - Nicholas W. Lange
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - David M. Salerno
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Ersilia M. DeFilippis
- Division of Cardiology, Department of Medicine Columbia University Irving Medical Center New York City, New York USA
| | - Danielle Kovac
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Heather Corbo
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Justin K. Chen
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Jason Y. Choe
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Jennifer H. Lee
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Anastasia Anamisis
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Douglas L. Jennings
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Giovanna Codispodo
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Tara Shertel
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Robert S. Brown
- Department of Medicine Weill Cornell Medicine New York City, New York USA
| | - Marcus R. Pereira
- Department of Medicine Vagelos College of Physicians and Surgeons New York City, New York USA
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Lange NW, Salerno DM, Jennings DL, Choe J, Hedvat J, Kovac DB, Scheffert J, Shertel T, Ratner LE, Brown RS, Pereira MR. Nirmatrelvir/ritonavir use: Managing clinically significant drug-drug interactions with transplant immunosuppressants. Am J Transplant 2022; 22:1925-1926. [PMID: 35015924 DOI: 10.1111/ajt.16955] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Nicholas W Lange
- Department of Pharmacy, NewYork-Presbyterian Hospital Pharmacy, New York, New York, USA
| | - David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital Pharmacy, New York, New York, USA
| | - Douglas L Jennings
- Department of Pharmacy, NewYork-Presbyterian Hospital Pharmacy, New York, New York, USA
| | - Jason Choe
- Department of Pharmacy, NewYork-Presbyterian Hospital Pharmacy, New York, New York, USA
| | - Jessica Hedvat
- Department of Pharmacy, NewYork-Presbyterian Hospital Pharmacy, New York, New York, USA
| | - Danielle Bley Kovac
- Department of Pharmacy, NewYork-Presbyterian Hospital Pharmacy, New York, New York, USA
| | - Jenna Scheffert
- Department of Pharmacy, NewYork-Presbyterian Hospital Pharmacy, New York, New York, USA
| | - Tara Shertel
- Department of Pharmacy, NewYork-Presbyterian Hospital Pharmacy, New York, New York, USA
| | - Lloyd E Ratner
- Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Robert S Brown
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Marcus R Pereira
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Sabatino DC, Hedvat J, Salerno DM, Lange NW. Maribavir does not significantly influence tacrolimus dose requirements in solid organ transplant recipients. Transpl Infect Dis 2022; 24:e13869. [DOI: 10.1111/tid.13869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
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7
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Salerno DM, Jennings DL, Lange NW, Kovac D, Shertel T, Chen JK, Hedvat J, Scheffert J, Brown RS, Pereira MR. Early clinical experience with nirmatrelvir/ritonavir for the treatment of COVID-19 in solid organ transplant recipients. Am J Transplant 2022; 22:2083-2088. [PMID: 35278260 PMCID: PMC9111190 DOI: 10.1111/ajt.17027] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/06/2022] [Accepted: 03/06/2022] [Indexed: 01/25/2023]
Abstract
Nirmatrelvir/ritonavir (NR) use has not yet been described in solid organ transplant recipients (SOTRs) with mild COVID-19. The objective was to evaluate outcomes among SOTR and describe the drug-drug interaction of NR. This is an IRB-approved, retrospective study of all adult SOTR on a calcineurin inhibitor (CNI) or mammalian target of rapamycin inhibitor who were prescribed NR between December 28, 2021 and January 6, 2022. A total of 25 adult SOTR were included (n = 21 tacrolimus, n = 4 cyclosporine, n = 3 everolimus, n = 1 sirolimus). All patients were instructed to follow the following standardized protocol during treatment with 5 days of NR: hold tacrolimus or mTOR inhibitor or reduce cyclosporine dose to 20% of baseline daily dose. Four patients (16%) were hospitalized by day 30; one for infectious diarrhea and three for symptoms related to COVID-19. No patients died within 30 days of receipt of NR. Median tacrolimus level pre- and post-NR were 7.4 ng/ml (IQR, 6.6-8.6) and 5.2 (IQR, 3.6-8.7), respectively. Four patients experienced a supratherapeutic tacrolimus concentration after restarting tacrolimus post-NR. Our results show the clinically significant interaction between NR and immunosuppressive agents can be reasonably managed with a standardized dosing protocol. Prescribers should carefully re-introduce CNI after the NR course is complete.
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Affiliation(s)
- David M. Salerno
- Department of PharmacyNewYork‐Presbyterian Hospital PharmacyNew YorkNew YorkUSA
| | - Douglas L. Jennings
- Department of PharmacyNewYork‐Presbyterian Hospital PharmacyNew YorkNew YorkUSA
| | - Nicholas W. Lange
- Department of PharmacyNewYork‐Presbyterian Hospital PharmacyNew YorkNew YorkUSA
| | | | - Tara Shertel
- Department of PharmacyNewYork‐Presbyterian Hospital PharmacyNew YorkNew YorkUSA
| | - Justin K. Chen
- Department of PharmacyNewYork‐Presbyterian Hospital PharmacyNew YorkNew YorkUSA
| | - Jessica Hedvat
- Department of PharmacyNewYork‐Presbyterian Hospital PharmacyNew YorkNew YorkUSA
| | - Jenna Scheffert
- Department of PharmacyNewYork‐Presbyterian Hospital PharmacyNew YorkNew YorkUSA
| | - Robert S. Brown
- Department of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Marcus R. Pereira
- Department of MedicineColumbia University Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
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Hedvat J, Salerno DM, Kovac D, Scheffert JL, Corbo H, Chen J, Choe JY, Jennings DL, Anamisis A, Liu EC, Lee JH, Shertel T, Lange NW. Nitazoxanide treatment for norovirus infection in solid organ transplant recipients. Clin Transplant 2022; 36:e14594. [PMID: 35032413 DOI: 10.1111/ctr.14594] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/18/2022] [Accepted: 01/10/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Jessica Hedvat
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY
| | - David M Salerno
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY
| | - Danielle Kovac
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY
| | | | - Heather Corbo
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY
| | - Justin Chen
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY
| | - Jason Y Choe
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY
| | - Douglas L Jennings
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY.,Department of Pharmacy Practice, Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, New York, NY
| | | | - Esther C Liu
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY
| | - Jennifer H Lee
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY
| | - Tara Shertel
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY
| | - Nicholas W Lange
- NewYork-Presbyterian Hospital, Department of Pharmacy, New York, NY
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9
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Breslin NT, Hedvat J, Salerno DM, Jandovitz N, Patel C, Lee S, Lange NW. Comparing weight-based dosing of tacrolimus XR in obese and non-obese renal transplant recipients. Clin Transplant 2021; 36:e14529. [PMID: 34757669 DOI: 10.1111/ctr.14529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/15/2021] [Accepted: 10/30/2021] [Indexed: 11/30/2022]
Abstract
The recommended initial weight-based dose of extended-release (XR) tacrolimus (Envarsus XR) in kidney transplant recipients (KTR) is 0.14 mg/kg/day. However, no data exist regarding dosing recommendations for obese patients specifically. The aim of this study was to evaluate weight-based dosing requirements in a cohort of obese KTR who were initiated on de novo tacrolimus XR post-transplantation. The primary outcome was weight-based dosing requirements (mg/kg/day) on post-operative day (POD) 7 and 14. Of the 254 KTR, 81 (31%) were obese. The median therapeutic dose on POD7 was 0.1 versus 0.12 vs. 0.14 mg/kg/day in the BMI > 30 kg/m2 , BMI 25-30 kg/m2 , and BMI < 25 kg/m2 , respectively, (p = .0001). This result was similar on POD14; median therapeutic dose was 0.09 versus 0.11 versus 0.15 mg/kg/day in the BMI > 30 kg/m2 , BMI 25-30 kg/m2 , and BMI < 25 kg/m2 , respectively, (p < .001). Therapeutic dose on POD7 and POD14 based on ideal body was similar in all cohorts (p = .238, p = .923, respectively). This finding was supported by a strong linear relationship between ideal body weight (IBW) and therapeutic dose (r = .929). In both obese and non-obese KTR, IBW had a stronger correlation with the therapeutic dose for tacrolimus XR.
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Affiliation(s)
- Nadine T Breslin
- Department of Pharmacy, North Shore University Hospital, Manhasset, New York, USA
| | - Jessica Hedvat
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA
| | - David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Nicholas Jandovitz
- Department of Pharmacy, North Shore University Hospital, Manhasset, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
| | - Chandni Patel
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Sara Lee
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Nicholas W Lange
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA
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10
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Salerno DM, Thornberg ME, Lange NW, Hedvat J, Robbins H, Brown RS, Jennings D, Scheffert J. Less bleeding associated with apixaban versus other direct acting oral anticoagulation in solid organ transplant recipients. Clin Transplant 2021; 35:e14396. [PMID: 34165845 DOI: 10.1111/ctr.14396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/19/2021] [Accepted: 06/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate outcomes of bleeding and thrombosis resulting from the use of DOACs in a large cohort of SOT recipients. METHODS This was a single center, retrospective cohort study of adult kidney, heart, lung, and liver transplant recipients transplanted between August 2009 and May 2018. Patients were stratified into two groups: those who received apixaban (apixaban group) or those patients receiving either rivaroxaban or dabigatran (non-apixaban group). The primary endpoint was the cumulative incidence of bleeding while receiving DOAC therapy. The secondary endpoints were incidence of major bleeding and thrombosis at any time while receiving DOAC therapy. RESULTS A total of 106 patients were included; 70 patients received apixaban and 36 patients received non-apixaban anticoagulation. Cumulative incidence of any bleeding was lower in the apixaban group compared to the non-apixaban group at both 90 days (4.9% versus 16.1%) and 180 days (11.4% versus 24.9%, P = 0.034). Cumulative incidence of major bleeding (P = 0.686) and thrombosis (P = 0.515) were similar between groups. DOAC dosing congruent with the package insert(s) was associated with a lower risk of thrombosis. CONCLUSION Apixaban-based anticoagulation was associated with a lower cumulative incidence of any bleeding compared to non-apixaban DOACs. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, 10065, USA
| | - Megan E Thornberg
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, 10065, USA
| | - Nicholas W Lange
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, 10065, USA
| | - Jessica Hedvat
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, 10065, USA
| | - Hilary Robbins
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, 10032, USA
| | - Robert S Brown
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, 10065, USA
| | - Douglas Jennings
- Long Island University Department of Pharmacy Practice, New York, 11201, USA
| | - Jenna Scheffert
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, 10065, USA
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11
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Kovac D, Choe J, Liu E, Scheffert J, Hedvat J, Anamisis A, Salerno D, Lange N, Jennings DL. Immunosuppression considerations in simultaneous organ transplant. Pharmacotherapy 2021; 41:59-76. [PMID: 33325558 DOI: 10.1002/phar.2495] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/21/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022]
Abstract
Solid organ transplantation is a life-saving procedure for patients in the end stage of heart, lung, kidney, and liver failure. For patients with more than one failing organ, simultaneous organ transplantation has emerged as a viable treatment option. Immunosuppression strategies and outcomes for simultaneous organ transplant recipients have been reported, but often involve limited populations. Transplanting dual organs poses challenges in terms of balancing immunosuppression with immunologic risk and allograft damage from surgical complications. Furthermore, transplanting certain organs can impose considerations on the management of immunosuppression. For example, liver allografts may confer immunologic privilege and lower rates of rejection of other allografts. This review article evaluates immunosuppression strategies for simultaneous kidney-pancreas, liver-kidney, heart-kidney, heart-liver, heart-lung, lung-liver, and lung-kidney transplants. To date, no comprehensive review exists to address immunosuppressive strategies in simultaneous organ transplant populations. Our review summarizes the available literature and provides evidence-based recommendations regarding immunosuppression strategies in simultaneous organ transplant recipients.
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Affiliation(s)
- Danielle Kovac
- Department of Pharmacy, NewYork-Presbyterian Columbia University Irving Medical Center, New York, New York, USA
| | - Jason Choe
- Department of Pharmacy, NewYork-Presbyterian Columbia University Irving Medical Center, New York, New York, USA
| | - Esther Liu
- Department of Pharmacy, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Jenna Scheffert
- Department of Pharmacy, NewYork-Presbyterian Columbia University Irving Medical Center, New York, New York, USA
| | - Jessica Hedvat
- Department of Pharmacy, NewYork-Presbyterian Columbia University Irving Medical Center, New York, New York, USA
| | - Anastasia Anamisis
- Department of Pharmacy, NewYork-Presbyterian Columbia University Irving Medical Center, New York, New York, USA
| | - David Salerno
- Department of Pharmacy, NewYork-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Nicholas Lange
- Department of Pharmacy, NewYork-Presbyterian Columbia University Irving Medical Center, New York, New York, USA
| | - Douglas L Jennings
- Department of Pharmacy, NewYork-Presbyterian Columbia University Irving Medical Center, New York, New York, USA.,Division of Pharmacy Practice, Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, New York, New York, USA
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Hedvat J, Choe JY, Salerno DM, Scheffert JL, Kovac D, Anamisis A, Shertel TL, Lee JH, Liu EC, Lange NW. Managing the significant drug-drug interaction between tacrolimus and letermovir in solid organ transplant recipients. Clin Transplant 2021; 35:e14213. [PMID: 33438781 DOI: 10.1111/ctr.14213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Jessica Hedvat
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jason Y Choe
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jenna L Scheffert
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Danielle Kovac
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Anastasia Anamisis
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Tara L Shertel
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jennifer H Lee
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Esther C Liu
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Nicholas W Lange
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
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Salerno DM, Kovac D, Corbo H, Jennings DL, Lee J, Choe J, Scheffert J, Hedvat J, Chen J, Tsapepas D, Rosenblatt R, Samstein B, Halazun K, Verna E, Pereira M, Brennan C, Husain SA, Mohan S, Brown RS. SARS-CoV-2 infection increases tacrolimus concentrations in solid-organ transplant recipients. Clin Transplant 2021; 35:e14193. [PMID: 33336440 PMCID: PMC7883259 DOI: 10.1111/ctr.14193] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/05/2020] [Accepted: 12/10/2020] [Indexed: 12/24/2022]
Affiliation(s)
- David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Danielle Kovac
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Heather Corbo
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Douglas L Jennings
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA.,Division of Pharmacy Practice, Long Island University, New York, NY, USA
| | - Jennifer Lee
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jason Choe
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jenna Scheffert
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jessica Hedvat
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Justin Chen
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Demetra Tsapepas
- Department of Transplant Surgery, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Russell Rosenblatt
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
| | - Benjamin Samstein
- Department of Surgery, Division of Transplant Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Karim Halazun
- Department of Surgery, Division of Transplant Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Elizabeth Verna
- Department of Medicine, Division of Digestive & Liver Diseases, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Marcus Pereira
- Department of Medicine, Division of Infectious Disease, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Corey Brennan
- Department of Transplant Surgery, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Syed A Husain
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, NY, USA.,The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, NY, USA.,The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Robert S Brown
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
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14
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Hedvat J, Poladi N, Salerno DM, Dube GK, Lange NW. An evaluation of PJP prophylaxis and anemia among renal transplant recipients. Transpl Infect Dis 2020; 23:e13543. [PMID: 33280205 DOI: 10.1111/tid.13543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/19/2020] [Accepted: 11/29/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Dapone and atovaquone are therapeutic options for PJP prophylaxis in renal transplant recipients. The objective of this study was to evaluate the incidence of anemia in renal transplant recipients receiving these agents. METHODS This is an IRB-approved, retrospective analysis of adult renal transplant recipients who received either dapsone or atovaquone. The primary endpoint was the change in hemoglobin within 90 days of drug initiation. Other endpoints of interest included incidence and management of anemia at multiple time points post-transplant. Categorical variables were compared with Pearson's chi-squared or Fischer's exact test and continuous data were compared utilizing Wilcoxon rank-sum test. Statistical analyses were performed using Stata 14.2. RESULTS A total of 478 patients were screened for inclusion; 50 patients were evaluated in both the dapsone and atovaquone groups. In the dapsone and atovaquone groups, the median age was 52 and 50.5 years, 44% and 42% were Caucasian, and median time to treatment initiation was 27 and 39 days post-transplant, respectively. All patients receiving dapsone had normal G6PD function. There was no difference in baseline hemoglobin between groups (9.7 g/dL vs 9.8 g/dL, P = .83). The median nadir hemoglobin values were 8.6 g/dL and 9.6 g/dL in the dapsone and atovaquone groups, respectively (P = .047). The median decrease in hemoglobin from baseline to nadir was 1.3 g/dL in dapsone patients and 0.2 g/dL in atovaquone patients (P = .001). Dapsone was discontinued in 46% of patients, whereas atovaquone was discontinued in 18% (P = .001). CONCLUSION Among renal transplant recipients with normal G6PD activity, dapsone is associated with greater hemoglobin reductions and rates of drug discontinuation as compared to atovaquone.
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Affiliation(s)
- Jessica Hedvat
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Neha Poladi
- Department of Pharmacy, Wake Forest Baptist Health Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Geoffrey K Dube
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Nicholas W Lange
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, USA
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15
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Lange NW, Lee JH, Liu EC, Hedvat J, Weiner J, Sultan S. Deceased donor renal transplantation in patients on apixaban at time of transplant surgery: A case series. Clin Transplant 2020; 35:e14148. [PMID: 33222253 DOI: 10.1111/ctr.14148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Nicholas W Lange
- Department of Pharmacy, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Jennifer H Lee
- Department of Pharmacy, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Esther C Liu
- Department of Pharmacy, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Jessica Hedvat
- Department of Pharmacy, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Joshua Weiner
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Samuel Sultan
- Division of Transplant Surgery, Weill Cornell Medicine, New York, NY, USA
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16
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Lange NW, Hedvat J, Tsapepas DS, Salerno DM. Managing the significant interaction between XR tacrolimus and fluconazole in kidney transplant recipients. Clin Transplant 2020; 34:e14001. [PMID: 32564404 DOI: 10.1111/ctr.14001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Nicholas W Lange
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York
| | - Jessica Hedvat
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York
| | - Demetra S Tsapepas
- Department of Transplant Surgery, New York-Presbyterian Hospital, New York, New York
| | - David M Salerno
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York
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17
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Abstract
Recommendations regarding the appropriateness of renal transplantation in patients with prior hematologic malignancies are limited. Given the lack of available data, studies are needed to assess which of these patients will maximally benefit from renal transplantation. This study was undertaken to describe the incidence of new or recurrent malignancy as well as patient and allograft survival, acute rejection, and serious infections in patients with prior hematologic malignancies receiving renal transplantation. This was a single center retrospective review of all adult patients with a previous hematologic malignancy who received a living or deceased renal transplantation between January 2009 and January 2016. Eight renal transplantation recipients with prior hematologic malignancies were identified and followed for a minimum of 3 years. Six patients received prior chemotherapy and five had a prior hematopoietic stem cell transplant. Median time from remission to transplant was 2.6 years. Three-year patient and allograft survival were 87% and 75%, respectively. Three patients were diagnosed with new cancers within 3 years post-renal transplantation; one of which died from cancer-related complications with a functioning allograft. There was concern for recurrent hematologic malignancies in two patients based on serologic studies, but, both of these patients were alive with functioning allografts at 3-year follow-up. Our experience suggests that renal transplantation can be successfully performed in select patients with prior hematologic malignancy but with a significant risk for de novo malignancy post-transplant, which may be associated with an overall poor prognosis. Decisions regarding renal transplantation candidacy should be made based on risk stratification and multidisciplinary discussions with patients, hematologists, and transplant providers.
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Affiliation(s)
- Jessica Hedvat
- Department of Pharmacy, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Vinay Nair
- Division of Nephrology, Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
| | - Leandra Miko
- Department of Pharmacy, The Mount Sinai Hospital, New York, NY, USA
| | - Madhav C Menon
- Department of Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
- Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York, NY, USA
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