CHARLESTON, SC—VA researchers hope that a pharmacist-led intervention now being studied can improve care and outcomes for veterans who have had solid organ transplants.
The study—and the intervention—could have a positive impact on care for a significant number of veterans. While transplants may seem to be rare events, they are not unusual in the VA, where 20,000 to 25,000 veterans currently receive post-transplant care, according to an estimate by David Taber, PharmD, clinical pharmacy specialist at the Ralph Johnson VAMC and associate professor in the Division of Transplant Surgery at the Medical University of South Carolina both in Charleston, SC. He’s also co-author of an article in JMIR Research Protocols that outlined the intervention being studied in the VA.1.
Advances in immunosuppression have reduced the risk of organ rejection by 80% since the 1980s, but long-term survival has not markedly changed. That’s in part because the risk of adverse drug events has increased as the anti-rejection regimens have become more complex with increased toxicity, greater demands on patients and more drug interactions.
“The drugs are very, very effective at preventing rejection, which is now below 10%, but they have a lot of side effects,” Taber said.
Some of the most common side effects are gastrointestinal, including nausea, vomiting and diarrhea, but the drugs also can make patients more vulnerable to infections, worsen diabetes and hypertension. They also frequently have neurotoxicity, which may manifest as tremor or pain or even altered mental status or seizures, Taber explained.
“These are toxic, expensive, complex regimens, and it’s not easy to stay adherent,” he told U.S. Medicine. “It’s not just one pill once a day; it’s two or three anti-rejection medications, two or three times a day, plus other issues they have to deal with.”
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