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PHARMACEUTICAL CARE AND CHARACTERIZATION OF PATIENTS WAITLISTED FOR KIDNEY TRANSPLANTATION IN A THIRD LEVEL HOSPITAL

European Statement

Clinical Pharmacy Services

Author(s)

M. López López-Cepero, H. Padilla Castaño, G. Arrufat Goterris, P. Clares Rubio, T. Bonnin Garau, A. Tugores Vázquez, C. Martorell Puigserver.

Why was it done?

A pharmaceutical care consultation (PCC) was implemented for patients waitlisted for kidney transplantation (PWKT). The PCC focuses on transplant medication education, accurate medication history, allergy review, adherence assessment and self-perception of therapeutic complexity.

What was done?

Medication non-adherence is the major issue in transplantation, and it is associated with increased risk rejection, allograft loss and patients’ death.
Medication education after the transplant was not enough. Intervening before the transplant enabled pharmacists to know the patients and develop an individualized therapeutic plan, so the patients arrive as prepared as possible on the day of the transplant.

How was it done?

PWKT were scheduled in PCC and the pharmacist review their medical history and prescriptions. Patients were contacted by telephone for an interview. A face-to-face consultation was also possible.
PCC evaluate:
1) Clinical variables: etiology of renal pathology, comorbidities, previous transplantation, current renal replacement therapy (TRR), CYP3A5 genotype.
2) Medication: allergies, current medication plan, adherence (Morisky-Green test and electronic prescription record), organization and self-perception complexity.
3) Pharmaceutical interventions (PI): deprescribe or update current treatment, reinforce adherence, propose Monitored Dosage System (MDS) or pillbox, immunosuppressants education, arrange for a second PCC, contact with their community pharmacy, send to Pharmacogenetics Committee.

What has been achieved?

The PCC was implemented in June 2024. Among the first 4 months, 28 of the 58 PWKT have been evaluated.
Analyzing the clinical variables has allowed us to describe PWKT profile. Knowing how patients manage medication, as well as the perception they have about the importance of their treatment, helps to create an action plan and better prepare the patient for the transplant.
Given that one third of the patients were non-adherent, most of the PI focused on adherence reinforce, including additional monitoring, propose MDS or pillbox pillbox and resolve medication doubts.

What next?

The next step is to include a PCC in our clinical practice and get to visit all PWKT before the transplant.
It is needed to evaluate the impacts of PCC and PI as regards clinical outcomes. Detecting improvement actions will be enriching for patients care.
The PCC can be extended to other types of solid organ transplants.

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