Frontiers in immunology · 2025
The impact of pharmacists' interventions within the closed loop immunosuppressant management process on kidney transplant recipients: a retrospective cohort study.
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Chen Hongxia, Li Chuan, Ou Shengsong, Chen Xiaoyu
Аннотация
INTRODUCTION: Nowadays, kidney transplant recipients' primary challenge is improving graft function. However, they are rarely provided effective long-term instructions on immunosuppressant use after transplant. This study aimed to describe the experiences of a pharmacist-led, closed-loop immunosuppressant service (PLIS) in the transplant center of a general hospital in China.
METHODS: A retrospective pre-and post-intervention study was conducted in the transplantation department in a general hospital. Of the 347 patients receiving kidney transplants from August 2022 to August 2024 were enrolled. Eligible subjects were assigned into two groups (pre-intervention group and post-intervention group) according to the date (1 August 2023) when the pharmacist commenced participation in the post-transplant management for kidney transplant recipients. The intra-patient variation in immunosuppressant trough concentrations (Cmin) before and after the intervention was defined as the primary outcome. The secondary outcome was to assess the impact on renal function.
RESULTS: Among 347 patients (August 2022-2024), those managed post-intervention (from August 2023) showed improved target trough concentration (Cmin) attainment versus pre-intervention: tacrolimus (TAC, 72.4% vs. 58.3%, P=0.012), cyclosporine (CsA, 63.7% vs. 46.5%, P=0.037), mycophenolate (MMF, 76.0% vs. 65.3%, P=0.025), and sirolimus (SRL, 80.2% vs. 51.9%, P=0.018). Compared to pre-intervention, the percentage coefficient of variation (%CV) decreased significantly for TAC (18.28% vs. 8.92%, P=0.031) and CsA (22.97% vs. 7.14%, P=0.004) post-intervention, while MMF maintained high variability (CV >30%). SRL variability declined at 6-12 months (17.02% vs. 26.05%, P=0.194). Renal function improved post-intervention, with reductions in serum creatinine, urea nitrogen, cystatin C, and microproteinuria (P<0.05).
CONCLUSION: PLIS enhanced immunosuppressant management precision and graft outcomes, demonstrating its utility in standardizing post-transplant care.
METHODS: A retrospective pre-and post-intervention study was conducted in the transplantation department in a general hospital. Of the 347 patients receiving kidney transplants from August 2022 to August 2024 were enrolled. Eligible subjects were assigned into two groups (pre-intervention group and post-intervention group) according to the date (1 August 2023) when the pharmacist commenced participation in the post-transplant management for kidney transplant recipients. The intra-patient variation in immunosuppressant trough concentrations (Cmin) before and after the intervention was defined as the primary outcome. The secondary outcome was to assess the impact on renal function.
RESULTS: Among 347 patients (August 2022-2024), those managed post-intervention (from August 2023) showed improved target trough concentration (Cmin) attainment versus pre-intervention: tacrolimus (TAC, 72.4% vs. 58.3%, P=0.012), cyclosporine (CsA, 63.7% vs. 46.5%, P=0.037), mycophenolate (MMF, 76.0% vs. 65.3%, P=0.025), and sirolimus (SRL, 80.2% vs. 51.9%, P=0.018). Compared to pre-intervention, the percentage coefficient of variation (%CV) decreased significantly for TAC (18.28% vs. 8.92%, P=0.031) and CsA (22.97% vs. 7.14%, P=0.004) post-intervention, while MMF maintained high variability (CV >30%). SRL variability declined at 6-12 months (17.02% vs. 26.05%, P=0.194). Renal function improved post-intervention, with reductions in serum creatinine, urea nitrogen, cystatin C, and microproteinuria (P<0.05).
CONCLUSION: PLIS enhanced immunosuppressant management precision and graft outcomes, demonstrating its utility in standardizing post-transplant care.