心臓移植医療における移植薬剤師の役割と今後の展望

抄録

One year-mortality of end-stage heart failure is about 50%, which is comparable to those of terminal cancers. Recently, new curriculum for specialists of clinical pharmacology for chemotherapy of cancer has been released. Likewise, we need to create specialized clinical pharmacists for the management of end-stage heart failure.
These pharmacists will be called as “Transplant Pharmacist”. In this article, we will outline our effort as the special team for the management of the patients waiting for heart transplant and the post-heart transplant patients. Transplant pharmacists will play a pivotal role in this team activity. Prevention of thromboembolism in the patients with left ventricular assist device (LVAD) needs close therapeutic drug monitoring (TDM) and rapid feedback of data on warfarin. In addition to these actions, successful management of warfarin requires that the transplant pharmacists effectively counsel and educate these patients with LVAD. TDM of antibiotic drugs is also essential for treatment of infection with LVAD. On the other hand, immunosuppressant like cyclosporine, tacrolimus, mycophenolate mofetil and evelolimus have critical influence on graft rejection as well as susceptibility to infection. Transplant pharmacists should evaluate effective the plasma concentration of those drugs through Parmacokinetics/Pharmacodynamics (PK/PD). Immunosuppressant adherence is also a critical issue to heart transplant recipient. Therefore, constant counseling and educating to these patients from transplant pharmacists are necessary.
Transplant pharmacists skilled at PK/PD and TDM of cardiovascular, antibiotic and immunosuppressive drugs would be key talents in highly-sophisticated medicine in the future.