Report from the 2018 Consensus Conference on Immunomodulating Agents in Thoracic Transplantation: Access, Formulations, Generics, Therapeutic Drug Monitoring, and Special Populations.

Abstract In 2009, The International Society for Heart and Lung Transplantation recognized the importance and challenges surrounding generic drug immunosuppression. As experience with generics has expanded and comfort has increased, substantial issues have arisen since that time with other aspects of immunomodulation that have not been addressed, such as: access to medicines, alternative immunosuppression formulations, additional generics, implications on therapeutic drug monitoring, and implications to special populations such as pediatrics and older adults. The aim of this Consensus Document is to critically address each of these concerns, expand on the challenges and barriers, and provide therapeutic considerations for practitioners who manage cardiothoracic transplant patients.