Consensus Recommendations for Use of Maintenance Immunosuppression in Solid Organ Transplantation

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Published 29 August 2022

Joelle Nelson, Nicole Alvey, Lyndsey Bowman, Jamie Schulte, Maria Cristina Segovia, Jennifer McDermott, Helen S. Te, Nikhil Kapila, Deborah Jo Levine, Robert L. Gottlieb, Jose Oberholzer, Maya Campara

Pharmacotherapy Aug 2022;42(8):599-633.

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Pharmacotherapy Cover Vol 42 Number 9 August 2022

Advances in maintenance immunosuppression over the past three decades have improved solid organ transplantation outcomes dramatically. Uninterrupted access to immunosuppression is paramount to minimize rejection and maintain allograft and patient survival. There is no standardized approach to maintenance immunosuppression management. Agents used vary based on transplanted organ, center-specific protocol, provider expertise, insurance formularies, ability to cover co-pays, recipient characteristics and tolerability. Published data reflects this heterogeneity.

Despite this limitation, maintenance immunosuppression usage cross pollinates between organ groups with standard of care agents often being used off-label, making medication access a challenge for many transplant recipients.

For this guideline, a multidisciplinary panel of American transplant clinicians was formed to review published literature on maintenance immunosuppression with the goal to formulate consensus recommendations for their use in specific organ groups.

These consensus recommendations are intended to provide transplant clinicians with a summary of literature on maintenance immunosuppression in the modern era and to support transplant team members working to secure medication access for patients.

This document was endorsed by the International Society for Heart & Lung Transplantation (ISHLT), the American College of Clinical Pharmacy (ACCP), and the American Society of Transplantation (AST) in 2022.

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