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I read with keen interest the review by Gopal et al. in the journal. I am grateful for their great review. However, I would like to make some comments.
First, there are recent reports that demonstrate the superiority of quadruple or triple immunosupression versus traditional approach in terms of efficacy and safety. This positive outcome is mainly related to the use of tacrolimus as the cornerstone within the immunosuppressive treatment.
Second, in areas where Chagas disease is endemic, with migratory flows, reactivation should be considered when the donor has Latin-American origin, nowadays this complication has been recognized in USA and Europe.[4–5]
Third, the authors missed the important issue that transplant recipients may develop severe infection with Streptococcus pneumoniae, even in the early postransplant period. Vaccination has been recommended in heart, renal and liver recipients. Available vaccines are the 23-valent polysaccharide and the hepta- and decavalent protein conjugate.