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

Abstract

The roles of pharmacists in medication management for transplant recipients have received limited attention. This study comprehensively assessed the impact of pharmacist-led post-transplant medication management. A retrospective pre- and post-intervention study was conducted in the urology ward in a general hospital. Patients receiving kidney transplants from May 2015 to April 2017 were enrolled. Eligible subjects were assigned into two groups (pre-intervention group and post-intervention group) according to the date (1 May 2016) when the pharmacist commenced participation in the post-transplant management for kidney transplant recipients. The outcomes included intervention analysis, cost-saving effect, outcomes of immunosuppressive drug level monitoring, antibiotic outcomes, safety outcomes, and blood pressure (BP) and plasma glucose (PG) outcomes. A total of 299 patients were admitted to our hospital for kidney transplantation. Two hundred and four patients met inclusion criteria for this study (84 patients were in pre-intervention group, and 120 patients were in post-intervention group). Out of 630 pharmacist interventions in the medication order, 97.1% were accepted by the physicians. The average cost of medications per patient decreased from 4661.64 Ren Min Bi (RMB) to 3051.33 RMB. The percentage of patients who maintained tacrolimus (TAC) levels within the target concentration range was higher in the post-intervention group on post-operative day (POD) 7 (75.00% vs 87.50%, P=0.021). There was a significant decrease in antibiotic use density (AUD) and duration of antibiotic treatment in the post-intervention group. Post-intervention group showed lower levels in systolic blood pressure (SBP) (141.55±14.62 vs 136.04±13.17, P=0.01) with higher BP control rate (67.50% vs 90.70%, P=0.00) on discharge day compared to pre-intervention group. Pharmacists played a comprehensive role in the management of kidney transplant recipients in the inpatient setting, with some evidence of enhanced clinical outcomes.