title: Adverse symptoms of immunosuppressants: A survey of Canadian transplant clinicians.
abstract: Adverse symptoms of immunosuppressants (ASI) impact quality of life (QOL) in solid organ transplant recipients; however, standardized approaches for active ASI surveillance and intervention are lacking. While management is highly clinician dependent, clinician views remain largely unexplored. We surveyed Canadian Society of Transplantation members on their perceptions of ASI including frequency, perceived QOL impact, causal attribution, management strategies, and success. Sixty-one clinicians participated in the survey of 12 ASI (tremor, diarrhea, nausea, constipation, dyspepsia, insomnia, edema, dyspnea, arthralgia, acne, mouth sores, paresthesias), for a 22% response rate. Forty-nine completed the survey (80% completion rate). Diarrhea, dyspepsia, and insomnia were most frequent, requiring management in ≥ 2% of patients by 96%, 90%, and 82% of respondents, respectively. Diarrhea, insomnia, and dyspnea were deemed to have an important QOL impact by 92%, 82%, and 69%. Immunosuppressants were universally implicated as causative of tremor, diarrhea, acne, and mouth sores. Over 80% reported success in managing mouth sores, dyspepsia, and constipation. Management strategies included adjustment of immunosuppressant or other medications, drug therapy, and nonpharmacologic approaches and varied according to perceived causal attribution. More study is needed to compare clinician and patient views. These results will be used to establish priorities for further investigation of ASI.
authors.affiliation: Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada.|Department of Pharmacy Services, Toronto General Hospital, University Health Network, Toronto, ON, Canada.|Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
authors.forename: Jennifer J
authors.identifier: 0000-0003-1722-9584
authors.initials: JJ
authors.lastname: Harrison
authors.affiliation: College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada.|Saskatchewan Transplant Program, Saskatoon, SK, Canada.
authors.forename: Holly
authors.initials: H
authors.lastname: Mansell
authors.affiliation: Multi-Organ Transplant Program, BC Children's Hospital, Vancouver, BC, Canada.|Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Tom
authors.initials: T
authors.lastname: Blydt-Hansen
mesh_terms: D006801:Humans; D016377:Organ Transplantation / Q000009:adverse effects*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D011788:Quality of Life; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires
keywords: adverse effects; immunosuppression; organ transplantation; quality of life; survey