Abstract
Elderly patients with end-stage organ failure are now more frequently undergoing transplantation. Medication management in this population is challenging because of the combination of multiple comorbidities, polypharmacy, and immunological, pharmacokinetic and pharmacodynamic changes attributable to the aging process. Immunosuppressive medications can exacerbate pre-existing medical conditions and promote the development of disease processes.
Cardiovascular disorders, such as hypertension, coronary artery disease, congestive heart failure and arrhythmias are common in elderly transplant recipients, and account for most of the deaths in this population. Blood pressure, blood glucose and cholesterol control is of particular concern because elderly transplant recipients frequently have or develop these complications. Elderly transplant recipients are commonly receiving anticoagulation therapy with warfarin and are at a higher risk of bleeding, especially if they have renal dysfunction.
Infectious complications occur frequently in the transplanted population, with pneumonia being the most common infection seen in hospitalised patients. Attention to vaccination for the prevention of influenza and pneumococcal infections is important because of the increased risk of these diseases in this population. Depression itself has been associated with decreased survival in older individuals, and depression in elderly transplant recipients may be reversible with the administration of pharmacological agents.
Effective long-term care of transplant recipients demands an understanding of how particular medications affect clinical evaluation and treatment. This article addresses some of the practical issues surrounding medication management and prevention of these particular problems in elderly transplant recipients.
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References
Kinsella K, Velkoff VA, US Census Bureau. An aging world: 2001. Washington, DC: US Government Printing Office; 2001 Nov. Series P95/01-1
Kendrick E. Cardiovascular disease and the renal transplant recipient. Am J Kidney Dis 2001; 38: S36–43
Cameron JS. Renal transplantation in the elderly. Int Urol Nephrol 2000; 32: 193–201
Smith CM, Davies DB, McBride MA. Liver transplantation in the United States: a report from the UNOS Liver Transplant Registry. Clin Transpl 1999, 23–34
Garcia CE, Garcia RFL, Mayer AD, et al. Liver transplantation in patients over sixty years of age. Transplantation 2001; 72: 679–84
Keck BM, Bennett LE, Rosendale J, et al. Worldwide thoracic organ transplantation: a report from the UNOS/ISHLT International Registry for Thoracic Organ Transplantation. Clin Transpl 1999, 35–49
Ali Raza J, Movahed A. Use of cardiovascular medications in the elderly. Int J Cardiol 2002 Oct; 85(2–3): 203–15
Azad N, Tierney M, Victor G, et al. Adverse drug events in the elderly population admitted to a tertiary care hospital. J Healthc Manag 2002; 47: 295–305
Bia MJ. Geriatric issues in renal transplantation. Geriatr Nephrol Urol 1999; 9: 109–13
Balducci L, Extermann M. Management of cancer in the older person: a practical approach. Oncologist 2000; 5: 224–37
Balducci L, Stanta G. Cancer in the frail patient: a coming epidemic. Hematol Oncol Clin North Am 2000; 14: 235–50
British National Formulary. Ciclosporin. Vol. 46. London: The Pharmaceutical Press, 2003
British National Formulary. Tacrolimus. Vol. 46. London: The Pharmaceutical Press, 2003
Schaubel D, Desmeules M, Mao Y, et al. Survival experience among elderly end-stage renal disease patients: a controlled comparison of transplantation and dialysis. Transplant 1995; 60: 1389–94
Kasiske BL, Snyder J, Matas A, et al. The impact of transplantation on survival with kidney failure. Clin Transpl 2000, 135–43
Meier-Kriesche HU, Kaplan B. Immunosuppression in elderly renal transplant recipients: are current regimens too aggressive? Drugs Aging 2001; 18: 751–9
Rao VK. Kidney transplantation in older patients: risks and benefits. Drugs Aging 2002; 19(2): 79–84
Kappes U, Schanz G, Gerhardt U, et al. Influence of age on the prognosis of renal transplant recipients. Am J Nephrol 2001; 21: 259–63
De Fijter JW, Mallat MJK, Doxiadis IIN, et al. Increased immunogenicity and cause of graft loss of old donor kidneys. J Am Soc Nephrol 2001; 12: 1538–46
Grinyó JM. Borderline kidney graft donors: what are the problems? Nephrol Dial Transplant 2000; 15: 950–2
Basar H, Soran A, Shapiro R, et al. Renal transplantation in recipients over the age of 60: the impact of donor age. Transplantation 1999; 67: 1191–3
Verran DJ, de Leon C, Chui AK, et al. Factors in older cadaveric organ donors impacting on renal allograft outcome. Clin Transpl 2001; 15: 1–5
Carter JT, Lee CM, Weinstein RJ, et al. Evaluation of the older cadaveric kidney donor: the impact of donor hypertension and creatinine clearance on graft performance and survival. Transplantation 2000; 70: 765–71
Andres A, Morales JM, Herrero JC, et al. Double versus single renal allografts from aged donors. Transplantation 2000; 69: 2060–6
Tullius SG, Reutzel-Selke A, Egermann F, et al. Contribution of prolonged ischemia and donor age to chronic renal allograft dysfunction. J Am Soc Nephrol 2000; 11: 1317–24
Levy MF, Somasundar PS, Jennings LW, et al. The elderly liver transplant recipient: a call for caution. Ann Surg 2001 Jan; 233(1): 107–13
Hosenpud JD, Bennett LE, Keck BM, et al. The Registry of the International Society for Heart and Lung Transplantation: 18th official report, 2001. J Heart Lung Transplant 2001 Aug; 20(8): 805–15
Morgan JA, John R, Weinberg AD, et al. Long-term results of cardiac transplantation in patients 65 years of age and older: a comparative analysis. Ann Thorac Surg 2003 Dec; 76(6): 1982–7
Borkon AM, Muehlebach GF, Jones PG, et al. An analysis of the effect of age on survival after heart transplant. J Heart Lung Transplant 1999; 18: 668–74
Becker BN, Ismail N, Becker YT, et al. Renal transplantation in the older end stage renal disease patient. Semin Nephrol 1996; 16: 353–62
Bradley BA. Rejection and recipient age. Transpl Immunol 2002; 10: 125–32
Pahlavani MA, Harris MD, Richardson A. Activation of p21ras/MAPK signal transduction molecules decreases with age in mitogen-stimulated T cells from rats. Cell Immunol 1998; 185: 39–48
Gillis S, Kozak R, Durante M. Immunological studies of aging: decreased production of and response to T cell growth factor by lymphocytes from aged humans. J Clin Invest 1981; 67: 937–42
Fulop Jr T, Leblanc C, Lacombe G. Cellular distribution of protein kinase C isozymes in CD3-mediated stimulation of human T lymphocytes with aging. FEBS Lett 1995; 375: 69–74
Bach MA. Influence of aging on T-cell subpopulations involved in the in-vitro generation of allogeneic cytotoxicity. Clin Immunol Immunopathol 1979; 13: 220–30
Bach MA. Lymphocyte-mediated cytotoxicity: effects of ageing, adult thymectomy and thymic factor. J Immunol 1977; 119: 641–7
Whisler RL, Liu B, Wu LC. Reduced activation of transcriptional factor AP-1 among peripheral blood T cells from elderly humans after PHA stimulation: restorative effect of phorbol diesters. Cell Immunol 1993; 152: 96–109
Fagiolo U, Amadori A, Biselli R. Quantitative and qualitative analysis of anti-tetanus toxoid antibody response in the elderly: humoral immune response enhancement by thymostimulin. Vaccine 1993; 11: 336–40
Palomar R, Ruiz JC, Cotorruelo JG, et al. Effect of recipient age on the clinical course of renal transplantation. Nefrologia 2001; 21: 386–91
Pehourcq F, Molimard M. Pharmacokinetics in the elderly. Rev Mal Respir 2002 Jun; 19(3): 356–62
O’Mahony D, O’Leary P, Quigley EM. Aging and intestinal motility: a review of factors that affect intestinal motility in the aged. Drugs Aging 2002; 19: 515–27
Schmucker DL. Liver function and phase I drug metabolism in the elderly: a paradox. Drugs Aging 2001: 18(11); 837–51
Zeeh J, Platt D. The aging liver: structural and functional changes and their consequences for drug treatment in old age. Gerontology 2002; 48: 121–7
Meier-Kriesche HU, Friedman G, Jacobs M, et al. Infectious complications in geriatric renal transplant patients: comparison of two immunosuppressive protocols. Transplantation 1999; 68: 1496–502
Kasiske BL. Epidemiology of cardiovascular disease after renal transplantation. Transplantation 2001; 72: S5–8
Schmidt A, Stefenelli T, Schuster E, et al. Informational contribution of noninvasive screening tests for coronary artery disease in patients on chronic renal replacement therapy. Am J Kidney Dis 2001; 37: 56–63
Bundgaard H, Boesgaard S, Mortensen SA. Effect of nitroglycerin in patients with increased pulmonary vascular resistance undergoing cardiac transplantation. Scand Cardiovasc J 1997; 31(6): 339–42
Jones TE, Morris RG. Pharmacokinetic interaction between tacrolimus and diltiazem: dose-response relationship in kidney and liver transplant recipients. Clin Pharmacokinet 2002; 41(5): 381–8
Sketris IS, Methot ME, Nicol D, et al. Effect of calciumchannel blockers on cyclosporine clearance and use in renal transplant patients. Ann Pharmacother 1994 Nov; 28(11): 1227–31
Hebert MF, Lam AY. Diltiazem increases tacrolimus concentrations. Ann Pharmacother 1999 Jun; 33(6): 680–2
Brockmoller J, Neumayer HH, Wagner K, et al. Pharmacokinetic interaction between cyclosporin and diltiazem. Eur J Clin Pharmacol 1990; 38(3): 237–42
Waldo AL. Long-term pharmacologic management of atrial fibrillation in the elderly. Am J Geriatr Cardiol 2002; 11: 233–44
Singh SN, Lewis HD, Fisher SG, et al. Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia. N Engl J Med 1995; 333: 77–82
Morrissey PE, Ramirez PJ, Gohh RY, et al. Management of thrombophilia in renal transplant patients. Am J Transplant 2002 Oct; 2(9): 872–6
Friedman GS, Meier-Kriesche HU, Kaplan B, et al. Hypercoagulable states in renal transplant candidates: impact of anticoagulation upon incidence of renal allograft thrombosis. Transplantation 2001 Sep; 72(6): 1073–8
Morris CD, Vega JD, Levy JH, et al. Warfarin therapy does not increase bleeding in patients undergoing heart transplantation. Ann Thorac Surg 2001 Sep; 72(3): 714–8
Go AS, Hylek EM, Phillips KA, et al., for the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention. JAMA 2001; 285: 2370–5
Feinberg WM, Blackshear JL, Laupacis A, et al. Prevalence, age distribution, and gender of patients with atrial fibrillation: analysis and implications. Arch Intern Med 1995; 155: 469–47
Morice MC, Serruys PW, Sousa JE, et al. A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med 2002; 346: 1773–80
Serruys PW, de Feyter PJ, Benghozi R, et al. The Lescol® Intervention Prevention Study (LIPS): a double blind, placebo-controlled, randomized trial of the long term effects of fluvastatin after successful transcatheter therapy in patients with coronary heart disease. Int J Cardiovasc Intervent 2001; 4: 165–72
Reddy VS, Chen AC, Johnson HK, et al. Cardiac surgery after renal transplantation. Am Surg 2002; 68: 154–8
Sander GE. High blood pressure in the geriatric population: treatment considerations. Am J Geriatr Cardiol 2002; 11: 223–32
Cohen D, Galbraith C. General health management and long-term care of the renal transplant recipient. Am J Kidney Dis 2001; 38: S10–24
Rahn KH, Barenbrock M, Fritschka E, et al. Effect of nitrendipine on renal function in renal-transplant patients treated with cyclosporin: a randomised trial. Lancet 2002; 354: 1415–20
Manske CL. Cardiovascular disease after renal transplantation: epidemiology and therapeutic strategies [letter]. Transpl Immunol 2001; 17(3): 4–12
Murphy SW, Foley RN, Parfrey PS. Screening and treatment for cardiovascular disease in patients with chronic renal disease. Am J Kid Dis 1998; 32 (5 Suppl. 3): S184–99
Kasiske BL, Vazquez MA, Harmon WE, et al. Recommendations for the outpatient surveillance of renal transplant recipients. J Am Soc Nephrol 2000; 11: S1–S86
Paton RR, Kane RE. Long-term diuretic therapy with metolazone of renal failure and the nephritic syndrome. J Clin Pharm 1977; 17: 243–51
Molnar GW, Read RC, Wright FE. Propanolol enhancement of hypoglycemic sweating. Clin Pharmacol Ther 1974; 15: 490–6
Perez-Stable E, Halliday R, Gardiner PS, et al. The effects of propanolol on cognitive function and quality of life. Am J Med 2000; 108: 359–65
Diggory P, Cassels-Brown A, Vail A, et al. Avoiding unsuspected respiratory side-effects of topical timolol with cardi-oselective or sympathomimetic agents. Lancet 1995; 345: 1604–6
Webster J, Koch H-F. Aspects of tolerability of centrally acting antihypertensive drugs. J Cardiovasc Pharmacol 1996; 27: S49–54
Cooper KL, McKiernan JM, Kaplan SA. Alpha-adrenoceptor antagonists in the treatment of benign prostatic hyperplasia. Drugs 1999; 57: 9–17
MacKay A, Isles C, Henderson I, et al. Minoxidil in the management of intractable hypertension. QJM 1981; 50: 174–90
Opelz G, Wujciak T, Ritz E. Association of chronic kidney graft failure with recipient blood pressure. Kidney Int 1998; 53: 217–22
Midtvedt K, Hartmann A, Holdaas H, et al. Efficacy of nifedipine or lisinopril in the treatment of hypertension after renal transplantation: a double-blind randomised comparative trial. Clin Transplant 2001; 15: 426–31
Border WA, Noble NA. Transforming growth factor beta in tissue fibrosis. N Engl J Med 1994; 331: 1286–92
Monton M, Castilla MA, Alvarez Arroyo MV, et al. Effects of angiotensin II on endothelial cell growth: role of AT-1 and AT-2 receptors. J Am Soc Nephrol 1998; 9: 969–74
Yusuf S, Gerstein H, Hoogwerf B, et al. Ramipril and the development of diabetes. JAMA 2001; 286: 1882–5
Stigant CE, Cohen J, Vivera M, et al. ACE inhibitors and angiotensin II antagonists in renal transplantation: an analysis of safety and efficacy. Am J Kidney Dis 2000; 35: 58–63
Schmieder RE, Schlaich MP, Klingbeil AU, et al. Update on reversal of left ventricular hypertrophy in essential hypertension (a meta-analysis of all randomized double-blind studies until December 1996). Nephrol Dial Transplant 1998; 13: 564–9
Klingbeil AU, Muller HJ, Delies C, et al. Regression of left ventricular hypertrophy by ATI receptor blockade in renal transplant recipients. Am J Hypertens 2000; 13: 1295–300
Scolapio JS, Bowen J, Lukens FJ, et al. Influence of tacrolimus and prednisone on serum lipids after liver transplantation. J Parenter Enterai Nutr 2001; 25: 148–51
Miettinen TA, Pyorala K, Olsson AG, et al. Cholesterollowering therapy in women and elderly patients with myocar-dial infarction or angina pectoris: findings from the Scandinavian Simvastatin Survival Study (4S). Circulation 1997; 96: 4211–8
Lewis SJ, Moye LA, Sacks FM, et al. Effect of pravastatin on cardiovascular events in older patients with myocardial infarction and cholesterol levels in the average range: results of the Cholesterol and Recurrent Events (CARE) trial. Ann Intern Med 1998; 129: 681–9
Hunt D, Young P, Simes J, et al. Benefits of pravastatin on cardiovascular events and mortality in older patients with coronary heart disease are equal to or exceed those seen in younger patients: results for the LIPID trial. Ann Intern Med 2001; 134: 931–40
Ayanian JZ, Landrum MB, McNeil BJ. Use of cholesterollowering therapy by elderly adults after myocardial infarction. Arch Intern Med 2002; 162: 1013–9
Divakar D, Bailey RR, Price M, et al. Effect of diet on post-transplant hyperlipidaemia. NZ Med J 1992 Mar; 105(929): 79–80
St Peter WL, Clark JL, Levos OM. Drug therapy in haemodialysis patients: special considerations in the elderly. Drugs Aging 1998; 12: 441–59
Ligtenberg G, Hene RJ, Blankestijn PJ, et al. Cardiovascular risk factors in renal transplant patients: cyclosporin A versus tacrolimus. J Am Soc Nephrol 2001; 12: 368–73
Scott JT. Drug-inducted gout. Baillieres Clin Rheumatol 1991; 5(1): 39–60
Mignat C. Clinically significant drug interactions with new immunosuppressive agents. Drug Saf 1997 Apr; 16(4): 267–78
Calmus Y, Conti F, Dousset B, et al. Hepatic allograft rejection: diagnostic and therapeutic aspects. Therapie 1992 Jul–Aug; 47(4): 265–72
Jensen RA, Lal SM, Diaz-Arias A, et al. Does cholestyramine interfere with cyclosporine absorption: a prospective study in renal transplant patients. ASAOI J 1995 Jul–Sep; 41(3): M704–6
Groggel GC, Cheung AK, Ellis-Benigni K, et al. Treatment of nephrotic hyperlipoproteinemia with gemfibrozil. Kidney Int 1989; 36: 266–71
Evans JR, Forland SC, Cutler RE. The effect of renal function on the pharmacokinetics of gemfibrozil. J Clin Pharmacol 1987; 27: 994–1000
Elisaf MS, Dardamanis MA, Papagalanis ND, et al. Lipid abnormalities in chronic uremic patients: response to treatment with gemfibrozil. Scand J Urol Nephrol 1993; 27: 101–8
Nawrocki JW, Weiss SR, Davidson MH, et al. Reduction of LDL cholesterol by 25% to 60% in patients with primary hypercholesterolemia by atorvastatin, a new HMG-CoA reductase inhibitor. Arterioscler Thromb Vasc Biol 1995; 15: 678–82
Kobashigawa JA, Kasiske BL. Hyperlipidemia in solid organ transplantation. Transplantation 1997; 63: 331–8
Castro R, Queiros J, Fonseca I, et al. Therapy of post-renal transplantation hyperlipidaemia: comparative study with simvastatin and fish oil. Nephrol Dial Transplant 1997; 12: 2140–3
Kandus A, Kovac D, Cerne D, et al. Therapy of hyperlipidemia with lovastatin in kidney transplant patients on cyclosporine A immunosuppression: three-year experience. Transplant Proc 1998; 30: 1307–9
Stapleton D, Mehra M, Dumas D, et al. Lipid-lowering therapy and long-term survival in heart transplantation. Am J Cardiol 1997; 80: 802–5
Cosio FG, Pesavento TE, Pelletier RP, et al. Patient survival after renal transplantation (III): the effects of statins. Am J Kidney Dis 2002; 40: 638–43
Wenke K, Meiser B, Thiery J, et al. Simvastatin initiated early after heart transplantation: 8-year prospective experience. Circulation 2003; 107: 93–7
Mehra MR, Uber PA, Vivekananthan K, et al. Comparative beneficial effects of simvastatin and pravastatin on cardiac allograft rejection and survival. J Am Coll Cardiol 2002; 40: 1609–14
Vrtovsnik F, Couette S, Prie D, et al. Lovastatin-induced inhibitions of renal epithelial cell proliferation involves a p21 ras activated, AP-1-dependent pathway. Kidney Int 1997; 52: 1016–27
Bae J, Jarcho JA, Denton MD, et al. Statin specific toxicity in organ transplant recipients: case report and review of the literature. J Nephrol 2002 May–Jun; 15(3): 317–9
Cosio FG, Pesavento TE, Osei K, et al. Post-transplant diabetes mellitus: increasing incidence in renal allograft recipients transplanted in recent years. Kidney Int 2001; 59: 732–7
Ericzon B, Groth C, Bismuth H, et al. Glucose metabolism in liver transplant recipients treated with FK 506 or cyclosporin in the European Multicentre Study. Transpl Int 1994; 7: S11–4
Midtvedt K, Hartmann A, Hjelmesaeth J, et al. Insulin resistance is a common denominator of post-transplant diabetes mellitus and impaired glucose tolerance in renal transplant recipients. Nephrol Dial Transplant 1998; 13: 427–31
Hjelmesaeth J, Hartmann A, Midtvedt K, et al. Metabolic cardiovascular syndrome after renal transplantation. Nephrol Dial Transplant 2001 May; 16(5): 1047–52
Lebovitz HE. Treating hyperglycemia in type 2 diabetes: new goals and strategies. Cleve Clin J Med 2002; 69: 809–20
Moore R, Boucher A, Carter J, et al. Diabetes mellitus in transplantation: 2002 consensus guidelines. Post-Transplant Diabetes Mellitus Advisory Board. Transplant Proc 2003 Jun; 35(4): 1265–70
Hatorp V. Clinical pharmacokinetics and pharmacodynamics of repaglinide. Clin Pharmacokinet 2002; 41: 471–83
Stumvoll M, Nurjhan N, Perriello G, et al. Metabolic effects of metformin in non-insulin dependent diabetes mellitus. N Engl J Med 1995; 333: 550–4
DeFronzo RA, Goodman AM. Efficacy of metformin in patients with non-insulin-dependent diabetes mellitus. N Engl J Med 1995; 333: 541–9
Bailey CJ, Turner RC. Drug therapy: metformin. N Engl J Med 1996; 334: 574–9
Lebovitz HE. Insulin resistance: definition and consequences. Exp Clin Endocrinol Diabetes 2001; 109: 135–48
Lebovitz HE, Banerji MA. Insulin resistance and its treatment by thiazolidinediones. Recent Prog Horm Res 2001; 56: 265–94
O’Moore-Sullivan TM, Prins JB. Thiazolidinediones and type 2 diabetes: new drugs for an old disease. Med J Aust 2002; 176: 381–6
Lebovitz HE, Kreider M, Freed MI. Evaluation of liver function in type 2 diabetic patients during clinical trials: evidence that rosiglitazone does not cause hepatic dysfunction. Diabetes Care 2002; 25: 815–23
Lebovitz HE. Oral therapies for diabetic hyperglycemia. Endocrinol Metab Clin North Am 2001; 30: 909–33
Helderman JH, Goral S. Gastrointestinal complications of transplant immunosuppression. J Am Soc Nephrol 2002; 13: 277–87
Stelzner M, Vlahakos DV, Milford EL, et al. Colonic perforations after renal transplantation. J Am Coll Surg 1997; 184: 63–9
Warshaw AL, Welch JP, Ottinger LW. Acute perforation of the colon associated with chronic corticosteroid therapy. Am J Surg 1976; 131: 442–6
Merrell SW, Ames SA, Nelson EW, et al. Major abdominal complications following cardiac transplantation: Utah Transplantation Affiliated Hospitals Cardiac Transplant Program. Arch Surg 1989; 124: 889–94
Tranaeus A, Heimburger O, Granqvist S. Diverticular disease of the colon: a risk factor for peritonitis in continuous peritoneal dialysis. Nephrol Dial Transplant 1990; 5: 141–7
McCune TR, Nylander WA, Van Buren DH, et al. Colonic screening prior to renal transplantation and its impact on posttransplant colonic complications. Clin Transplant 1992; 6: 91–6
Torregrosa JV. Immunosuppression and bone loss after transplantation. Transplant Proc 2001; 33: 3665–7
Haagsma EB, Thijn CJ, Post JG, et al. Bone disease after orthotopic liver transplantation. J Hepatol 1998; 6: 94–100
Riemens SC, Oostdijk A, van Doormaal JJ, et al. Bone loss after liver transplantation is not prevented by cyclical etidronate, calcium and alphacalcidol. Osteoporos Int 1996; 6: 213–8
Hommann M, Abendroth K, Lehmann G, et al. Effect of transplantation on bone: osteoporosis after liver and multivisceral transplantation. Transplant Proc 2002; 34: 2296–8
De Sevaux RG, Hoitsma AJ, Van Hoof HJ, et al. Abnormal vitamin D metabolism and loss of bone mass after renal transplantation. Nephron 2003; 93: C21–8
Hawkins FG, Leon M, Lopez MB, et al. Bone loss and turnover in patients with liver transplantation. Hepatogastroenterology 1994; 41: 158–61
Meys E, Fontanges E, Fourcade N, et al. Bone loss after orthotopic liver transplantation. Am J Med 1994; 97: 445–50
Monegal A, Navasa M, Guañabens N, et al. Osteoporosis and bone mineral metabolism disorders in cirrhotic patients referred for orthotopic liver transplantation. Calcif Tissue Int 1997; 60: 148–54
Pisani B, Mullen GM. Prevention of osteoporosis in cardiac transplant recipients. Curr Opin Cardiol 2002; 17: 160–4
Saag K, Emkey R, Schnitzer T, et al. Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis. N Engl J Med 1998; 339: 292–9
Shane E, Rodino M, McMahon D, et al. Prevention of bone loss after heart transplantation with antiresorptive therapy: a pilot study. J Heart Lung Transplant 1998; 17: 1089–96
Krieg MA, Seydoux C, Sandini L, et al. Intravenous pamidronate as treatment for osteoporosis after heart transplantation: a prospective study. Osteoporos Int 2001; 12: 112–6
Trzepacz PT, Maue FR, Coffman G, et al. Neuropsychiatric assessment of liver transplantation candidates: delirium and other psychiatric disorders. Int J Psychiatry Med 1986; 16: 101–11
Dew MA, Roth LH, Schulberg HC, et al. Prevalence and predictors of depression and anxiety-related disorders during the year after heart transplantation. Gen Hosp Psychiatry 1996; 18: 48–61S
Lake KD. Management of drug interactions with cyclosporine. Pharmacotherapy 1991; 11(5): 110–118S
Vella JP, Sayegh M. Interactions between cyclosporine and newer antidepressant medications. Am J Kidney Dis 1998; 31: 320–3
Helms-Smith KM, Curtis SL, Hatten RC. Apparent interaction between nefazodone and cyclosporine [letter]. Ann Intern Med 1996; 125: 424
Wright DH, Lake KD, Bruhn PS, et al. Nefazodone and cyclosporine drug-drug interaction. J Heart Lung Transplant 1999; 18: 913–5
Horton RC, Bonser RS. Interaction between cyclosporin and fluoxetine. BMJ 1995; 311: 422
Strouse TB, Fairbanks LA, Skotzko CE, et al. Fluoxetine and cyclosporine in organ transplantation. Psychosomatics 1996; 37: 23–30
Markowitz JS, Gill HE, Hunt NM, et al. Lack of antidepressant-cyclosporine pharmacokinetic interactions. J Clin Psycho-pharmacol 1998; 18: 91–3
Willetts J, Lippa A, Beer B. Clinical development of citalopram. J Clin Psychopharmacol 1999; 19: 36S–46S
Liston HL, Markowitz JS, Hunt N, et al. Lack of citalopram effect on the pharmacokinetics of cyclosporine. Psychosomatics 2001 Jul–Aug; 42(4): 370–2
Gravenstein S, Davidson HE. Current strategies for management of influenza in the elderly population. Clin Infect Dis 2002; 35: 729–37
Treanor J, Falsey A. Respiratory viral infections in the elderly. Antiviral Res 1999; 44: 79–102
Kasiske B. Long-term posttransplantation management and complications. In: Danovitch GM, editor. Handbook of kidney transplantation. 3rd ed. Philadelphia (PA): Lippincott Williams & Wilkins, 2001: 182–220
Butler JC, Schuchat A. Epidemiology of pneumococcal infections in the elderly. Drugs Aging 1999; 15: 11–9
Penn I, Hammond W, Brettschneider L, et al. Malignant lymphomas in transplantation patients. Transplant Proc 1969; 1: 106–12
Harden PN, Reece SM, Fryer AA, et al. Skin cancer surveillance in renal transplant recipients: questionnaire survey of current UK practice. BMJ 2001; 323: 600–1
London NJ, Farmery SM, Will EJ, et al. Risk of neoplasia in renal transplant patients. Lancet 1995; 72: 403–6
Penn I. The changing patterns of post-transplant malignancies. Transplant Proc 1991; 23: 1101–3
Euvrard S, Kanitakis J, Pouteil-Noble C. Skin cancers in organ transplant recipients. Curr Opin Organ Transplant 1998; 3: 96–104
Barrett WL, First MR, Aron BS, et al. Clinical course of malignancies in renal transplant patients. Cancer 1993; 72: 2186–9
Opelz G, Henderson R. Incidence of non-Hodgkin lymphoma in kidney and heart transplant recipients. Lancet 1993; 342: 1514–6
Penn I. De novo cancers in organ allograft recipients. Curr Opin Organ Transplant 1998; 3: 188–96
Winkelhorst JT, Brokelman WJ, Tiggeler RG, et al. Incidence and clinical course of de-novo malignancies in renal allograft recipients. Eur J Surg Oncol 2001; 27: 409–13
Danpanich E, Kasiske BL. Risk factors for cancer in renal transplant recipients. Transplantation 1999; 68: 1859–64
Haagsma EB, Hagens VE, Schaapveld M, et al. Increased cancer risk after liver transplantation: a population-based study. J Hepatol 2001 Jan; 34(1): 84–91
Fabia R, Levy MF, Testa G, et al. Colon carcinoma in patients undergoing liver transplantation. Am J Surg 1998; 176: 265–9
Knechtle SJ, D’Alessandro AM, Harms BA, et al. Relationships between sclerosing cholangitis, inflammatory bowel disease, and cancer in patients undergoing liver transplantation. Surgery 1995; 118: 615–9
Orth SR, Ritz E, Schrier RW. The renal risks of smoking. Kidney Int 1997; 51: 1669–77
Kalker AJ, Pirsch JD, Heisey D, et al. Foot problems in the diabetic transplant recipient. Clin Transplant 1996; 10: 503–10
Weitzner MA, Haley WE, Chen H. The family caregiver of the older cancer patient. Hematol Oncol Clin North Am 2000; 14: 269–81
Balducci L, Extermann M. Management of the frail cancer patient. Crit Rev Oncol Hematol 2000; 33: 143–8
Corcoran MB. Polypharmacy in the older patient. In: Balducci L, Lyman GH, Ershler WB, editors. Comprehensive geriatric oncology. London: Harwood Academic Publishers, 1997: 525–32
Wenger NK. Lipid metabolism, physical activity, and postmenopausal hormone therapy. Am J Kidney Dis 1998; 32: S80–8
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Bernardo, J.F., McCauley, J. Drug Therapy in Transplant Recipients. Drugs Aging 21, 323–348 (2004). https://doi.org/10.2165/00002512-200421050-00004
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DOI: https://doi.org/10.2165/00002512-200421050-00004