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Drug related toxicity in lung transplant recipients
M.. van Zellera, C.. Damasb,
Corresponding author
cdamas@aeiou.pt

Corresponding author. cdamas@aeiou.pt
a Serviço de Pneumologia, Centro Hospitalar de São João, Porto, Portugal
b Consulta Especializada de Transplante Pulmonar, Serviço de Pneumologia, Centro Hospitalar de São João, Porto, Portugal
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    "textoCompleto" => "<p class="elsevierStylePara">During the last two decades&#44; lung transplantation &#40;LTx&#41; has become a life-saving intervention for patients presenting with end-stage respiratory disease&#46;<a href="&#35;bib5" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a></p><p class="elsevierStylePara">The lung graft&#44; in contrast to all other transplanted organs&#44; is in permanent contact with the external environment and is thus exposed to various inhaled agents&#46; Moreover&#44; it contains a huge amount of donor antigen-presenting cells constantly processing and presenting HLA alloantigens to recipient lymphocytes that initiate a process of immune recognition&#46;<a href="&#35;bib6" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> Thus a successful lung transplant relies on an appropriate immunosuppressive strategy and balance&#46;<a href="&#35;bib7" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> In fact the two main causes of death after LTx are chronic rejection of the allograft and infections&#46;</p><p class="elsevierStylePara">Although advances have been made and varied immunosuppressive protocols are being used&#44; specific drugs&#44; such as calcineurin inhibitors and proliferation inhibitors &#40;PIs&#41;&#44; are very toxic&#44; even at low doses&#46; Nevertheless&#44; they are considered to be indispensable in lung transplantation&#46;<a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> Thus&#44; with LTx came along drug toxicity&#46;</p><p class="elsevierStylePara">We would like to report the results of our own series&#46;</p><p class="elsevierStylePara">We retrospectively evaluated patients with pulmonary transplantation followed at our Centre since 2005&#46; The lung transplant was performed by two different transplantation Groups &#8211; Hospital de Santa Marta &#40;Lisbon&#41; and at Hospital Juan Canalejo &#40;Corunha&#41;&#44; according to the Portuguese Health System indications for lung transplant&#46; After the transplant&#44; although patients still maintained follow-up at the transplant centre&#44; they were referred to our Specialized Clinic for Lung Transplanted patients which works very closely with both centres&#46;</p><p class="elsevierStylePara">Thirty-two patients were included&#44; 19 &#40;59&#46;4&#37;&#41; were male&#59; the mean age at transplant was 44&#46;9 years&#46; The patients have been followed for a mean time of 30&#46;78 months after LTx&#46; The initial immunosuppressive protocol used in all patients was the association of steroids&#44; cyclosporine and azathoprine&#46; Only six patients are still with it&#44; in 20 patients it was changed due to acute rejection and in six patients due to chronic rejection&#46;</p><p class="elsevierStylePara">In 14 patients the immunosuppressive therapy had to be changed&#44; more than once&#44; due to drug induced toxicity&#46; Two patients had malignancy diagnosis &#40;lymphoma&#41;&#44; gastric symptoms were the most frequent complaint&#44; renal malfunction&#44; hirsutism &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;1&#41;&#44; and gingival hyperplasia &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;1&#41; were some of the complications the authors would like to report&#46; No relationship was found between the need to change the therapy and age at transplant or time of follow-up&#46;</p><p class="elsevierStylePara">Among the diseases that needed to be treated but did not require an immunosuppressive therapy change&#44; diabetes &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;10&#44; 31&#46;5&#37;&#41;&#44; dislipidemia &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;12&#44; 37&#46;5&#37;&#41; and arterial hypertension &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;4&#44; 12&#46;5&#37;&#41; were found to be the most prevalent&#46;</p><p class="elsevierStylePara">Lung transplantation may be a life-saving intervention for end-stage respiratory disease&#46; With the growing number of long-term survivors of lung transplants&#44; chronic rejection and toxicity have emerged as major problems&#46; Drug induced toxicity is prevalent and the clinicians caring for those patients have to be well aware of this so that it can be diagnosed&#44; addressed and treated as early as possible&#46;</p><a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors declare no conflicts of interest&#46;</p><p class="elsevierStylePara">Corresponding author&#46; cdamas&#64;aeiou&#46;pt</p>"
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Pulmonology

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