Impact of a Clinical Solid Organ Transplant Pharmacist on Tacrolimus Nephrotoxicity, Therapeutic Drug Monitoring, and Institutional Revenue Generation in Adult Kidney Transplant Recipients

Abstract

Of the 70 kidney transplant recipients in the postpharmacist cohort, 18 (25.7%) experienced nephrotoxicity while on tacrolimus, compared to 18 (25%) of the 72 in the prepharmacist cohort ( P = .922). A significantly greater proportion of recipients who experienced nephrotoxicity were male, had hypertension, or experienced delayed or slow graft function. The rate of appropriately drawn tacrolimus troughs significantly increased from 23.4% to 30.3% in the postpharmacist cohort ( P < .001). The median outpatient pharmacy revenue generated per recipient significantly increased from US$345.49 (interquartile range [IQR]: 0-4727.56) to US$4834.95 per recipient (IQR: 3592.78-6224.60; P < .001). The length of stay (7 days, IQR: 6-9, vs 8 days, IQR: 6-9; P = .107) and the 30-day readmission rate were similar between groups (20.8% vs 21.4%; P = .931).

Cynomolgus monkeys are successfully and persistently infected with hepatitis E virus genotype 3 (HEV-3) after long-term immunosuppressive therapy

“…Common side effects of tacrolimus medication include nephrotoxicity, neurotoxicity, hepatotoxicity, and new-onset diabetes mellitus after transplantation (NOADT) [ 21 , 60 ]. In order to assess the possible toxic effects of tacrolimus, we opted to include a control group (G3) of tacrolimus-treated-not-infected monkeys.…”

“…Different types of immunosuppressants can modulate viral infection by inhibiting host immunity and/or directly affecting the virus life cycle. Tacrolimus is a potent macrolide immunosuppressant derived from Streptomyces tsukubaensis (calcineurin pathway inhibitor) and the most common medication employed to reduce the rate of rejection, especially in parenchymal organ transplantation [ 21 ]. The use of tacrolimus is the most important risk factor associated with chronic hepatitis in SOT recipients infected with HEV-3 [ 19 ].…”

Cynomolgus monkeys (Macaca fascicularis) experimentally and naturally infected with hepatitis E virus: The bone marrow as a possible new viral target

“…Further, human cases of persistent HEV-3 infection evolving to chronic hepatitis were described in solid organ transplant (SOT) patients under immunosuppressive therapy with, e.g. tacrolimus, considered a potent macrolide immunosuppressant derived from Streptomyces tsukubaensis (calcineurin pathway inhibitor) and a first-line medication employed to reduce the rate of rejection, especially in parenchymal organ transplantation [ 9 ]. High doses of tacrolimus showed to promote infection of liver cells with HEV in cell culture models [ 10 ].…”

Impact of pharmacist‐led post‐transplant medication management for kidney transplant recipients: A retrospective pre‐ and post‐intervention study

“…This was the most comprehensive study evaluating the effectiveness of pharmacist-led management of post-transplant medication for kidney transplant recipients on clinical outcomes compared to previously published literature. [14][15][16] Interventions by a pharmacist significantly reduced the cost of medication. The average cost of medications per patient decreased from 4661.64 to 3051.33 RMB in our study.…”