Author + information
- Richa Gupta, MD, MPH∗ (, )
- Kelly Schlendorf, MD and
- JoAnn Lindenfeld, MD
- ↵∗Vanderbilt University Medical Center, 1215 21st Avenue South, Nashville, Tennessee 37232-8802
We thank Drs. Weinrauch and D'Elia for their interest in our paper (1) and are pleased that they support the concept of personalizing immunosuppression (IS) regimens to account for comorbidities in aging transplant recipients and agree that complications of IS threaten survival.
Regarding calcium-channel blockers, we do not have any evidence that these agents are associated with improved infectious outcomes in the post-transplantation population. With respect to malignancy, however, calcium-channel blockers have been purported in published research to either be associated with an increased risk for cancer (most commonly) (2) or to confer protection from malignancy (3). Much of this debate, unfortunately, has stemmed from nonrandomized, observational, and even small randomized trials that are quite limited by selection and ascertainment biases. None of these associations have ultimately been confirmed in large-scale clinical trials (4).
Better understanding of IS and its specific effects on cancer, infection, graft dysfunction, and rejection will certainly allow reduction of risk due to excess death from complications of IS and result in improved outcomes. Development of a broad, searchable dataset of solid organ transplantations accessible to all investigators, as described in the letter, would be an excellent start.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2018 American College of Cardiology Foundation