PhD defence M.B. (Midas) Mulder

Brief summary of the doctoral thesis:

In the next decades, due to technological developments, healthcare providers will have to deal with an increase in the diagnostic possibilities, surgical techniques and new innovative drugs. Furthermore, the care for liver transplant recipients will become more complex due to an increase in comorbidities. In this thesis we showed that adapting immunosuppressive agents based on patients comorbidities and side effects is essential in order to modify and minimize immunosuppressive related toxicity. We showed that LCP-tacrolimus provides better results compared to ER-tacrolimus. Secondly, based on findings in this thesis we suggested that low-dose ribavirin for at least 180 days has a positive effect on hepatitis E virus clearance in solid organ transplant recipients. Next, immunosuppressive agents affecting the B lymphocytes reduce the immunogenicity of vaccination in LT recipients. This should be taken into account when vaccinating LT recipients. Finally, liver transplantation is only possible with a multidisciplinary team and interprofessional collaborations. Until the start of this thesis, in the Netherlands clinical pharmacists were solely involved in therapeutic drug monitoring of immunosuppressive agents and computerized medication monitoring. In this thesis, we showed that clinical pharmacists can have an added value in the clinical and outpatient transplant care and increase the medication safety and efficacy for these patients. Overall, we added new insights to the field of optimizing drug therapy for LT recipients in order to improve patient outcomes.