Optimizing drug therapy in liver transplantation: For better patient outcomes

Research output: Types of ThesisDoctoral ThesisInternal

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Abstract

In this thesis we showed that adapting immunosuppressive agents based on patients’ comorbidities and side effects is essential in order to modify and minimize immunosuppressive related toxicity (i.e. renal insufficiency, hypertension, post-transplant diabetes mellitus). We showed that 1) once-daily low-dose SRL combined with low-dose extended-release tacrolimus does ultimately not provide less chronic kidney disease grade ≥3 at 36 months compared to normal-dose extended release tacrolimus (LOL study) and 2) LCP-tacrolimus provides better results compared to ER-tacrolimus (MOTTO study).

Based on findings in this thesis we suggested that low-dose ribavirin for at least 180 days has a positive effect on hepatitis E virus clearance in solid organ transplant recipients. Next, immunosuppressive agents affecting the B lymphocytes reduce the immunogenicity of vaccination in LT recipients. This should be considered when vaccinating LT recipients.

Finally, until the start of this thesis, in the Netherlands clinical pharmacists were solely involved in therapeutic drug monitoring of immunosuppressive agents and computerized medication monitoring. In this thesis, we showed that clinical pharmacists can have an added value in the clinical and outpatient transplant care and increase the medication safety and efficacy for these patients. Overall, we added new insights to the field of optimizing drug therapy for LT recipients to improve patient outcomes.
Original languageEnglish
Awarding Institution
  • Erasmus University Rotterdam
Supervisors/Advisors
  • Metselaar, Herold, Supervisor
  • de Winter, Brenda, Co-supervisor
Award date5 Jun 2024
Place of PublicationRotterdam
Print ISBNs978-94-6473-437-9
Publication statusPublished - 5 Jun 2024

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