Impact of electronic health record-based, pharmacist-driven valganciclovir dose optimization in solid organ transplant recipients

David Hensler, Chad L. Richardson, Joslyn Brown, Christine Tseng, Phyllis J. Decamp, Amy Yang, Anna Pawlowski, Bing Ho, Michael G. Ison*

*Corresponding author for this work

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Prophylaxis with valganciclovir reduces the incidence of cytomegalovirus (CMV) infection following solid organ transplant (SOT). Under-dosing of valganciclovir is associated with an increased risk of CMV infection and development of ganciclovir-resistant CMV. Methods: An automated electronic health record (EHR)-based, pharmacist-driven program was developed to optimize dosing of valganciclovir in solid organ transplant recipients at a large transplant center. Two cohorts of kidney, pancreas-kidney, and liver transplant recipients from our center pre-implementation (April 2011-March 2012, n = 303) and post-implementation of the optimization program (September 2012-August 2013, n=263) had demographic and key outcomes data collected for 1 year post-transplant. Results: The 1-year incidence of CMV infection dropped from 56 (18.5%) to 32 (12.2%, P =.05) and the incidence of breakthrough infections on prophylaxis was cut in half (61% vs 34%, P =.03) after implementation of the dose optimization program. The hazard ratio of developing CMV was 1.64 (95% CI 1.06-2.60, P =.027) for the pre-implementation group after adjusting for potential confounders. The program also resulted in a numerical reduction in the number of ganciclovir-resistant CMV cases (2 [0.7%] pre-implementation vs 0 post-implementation). Conclusions: An EHR-based, pharmacist-driven valganciclovir dose optimization program was associated with reduction in CMV infections.

Original languageEnglish (US)
Article numbere12849
JournalTransplant Infectious Disease
Volume20
Issue number2
DOIs
StatePublished - Apr 1 2018

Fingerprint

Electronic Health Records
Cytomegalovirus Infections
Pharmacists
Cytomegalovirus
Transplants
Ganciclovir
Incidence
Kidney
Pancreas
Demography
valganciclovir
Transplant Recipients
Liver
Infection

Keywords

  • cytomegalovirus
  • opportunistic infection
  • prophylaxis
  • valganciclovir

ASJC Scopus subject areas

  • Transplantation
  • Infectious Diseases

Cite this

Hensler, David ; Richardson, Chad L. ; Brown, Joslyn ; Tseng, Christine ; Decamp, Phyllis J. ; Yang, Amy ; Pawlowski, Anna ; Ho, Bing ; Ison, Michael G. / Impact of electronic health record-based, pharmacist-driven valganciclovir dose optimization in solid organ transplant recipients. In: Transplant Infectious Disease. 2018 ; Vol. 20, No. 2.
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title = "Impact of electronic health record-based, pharmacist-driven valganciclovir dose optimization in solid organ transplant recipients",
abstract = "Background: Prophylaxis with valganciclovir reduces the incidence of cytomegalovirus (CMV) infection following solid organ transplant (SOT). Under-dosing of valganciclovir is associated with an increased risk of CMV infection and development of ganciclovir-resistant CMV. Methods: An automated electronic health record (EHR)-based, pharmacist-driven program was developed to optimize dosing of valganciclovir in solid organ transplant recipients at a large transplant center. Two cohorts of kidney, pancreas-kidney, and liver transplant recipients from our center pre-implementation (April 2011-March 2012, n = 303) and post-implementation of the optimization program (September 2012-August 2013, n=263) had demographic and key outcomes data collected for 1 year post-transplant. Results: The 1-year incidence of CMV infection dropped from 56 (18.5{\%}) to 32 (12.2{\%}, P =.05) and the incidence of breakthrough infections on prophylaxis was cut in half (61{\%} vs 34{\%}, P =.03) after implementation of the dose optimization program. The hazard ratio of developing CMV was 1.64 (95{\%} CI 1.06-2.60, P =.027) for the pre-implementation group after adjusting for potential confounders. The program also resulted in a numerical reduction in the number of ganciclovir-resistant CMV cases (2 [0.7{\%}] pre-implementation vs 0 post-implementation). Conclusions: An EHR-based, pharmacist-driven valganciclovir dose optimization program was associated with reduction in CMV infections.",
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author = "David Hensler and Richardson, {Chad L.} and Joslyn Brown and Christine Tseng and Decamp, {Phyllis J.} and Amy Yang and Anna Pawlowski and Bing Ho and Ison, {Michael G.}",
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Impact of electronic health record-based, pharmacist-driven valganciclovir dose optimization in solid organ transplant recipients. / Hensler, David; Richardson, Chad L.; Brown, Joslyn; Tseng, Christine; Decamp, Phyllis J.; Yang, Amy; Pawlowski, Anna; Ho, Bing; Ison, Michael G.

In: Transplant Infectious Disease, Vol. 20, No. 2, e12849, 01.04.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of electronic health record-based, pharmacist-driven valganciclovir dose optimization in solid organ transplant recipients

AU - Hensler, David

AU - Richardson, Chad L.

AU - Brown, Joslyn

AU - Tseng, Christine

AU - Decamp, Phyllis J.

AU - Yang, Amy

AU - Pawlowski, Anna

AU - Ho, Bing

AU - Ison, Michael G.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Background: Prophylaxis with valganciclovir reduces the incidence of cytomegalovirus (CMV) infection following solid organ transplant (SOT). Under-dosing of valganciclovir is associated with an increased risk of CMV infection and development of ganciclovir-resistant CMV. Methods: An automated electronic health record (EHR)-based, pharmacist-driven program was developed to optimize dosing of valganciclovir in solid organ transplant recipients at a large transplant center. Two cohorts of kidney, pancreas-kidney, and liver transplant recipients from our center pre-implementation (April 2011-March 2012, n = 303) and post-implementation of the optimization program (September 2012-August 2013, n=263) had demographic and key outcomes data collected for 1 year post-transplant. Results: The 1-year incidence of CMV infection dropped from 56 (18.5%) to 32 (12.2%, P =.05) and the incidence of breakthrough infections on prophylaxis was cut in half (61% vs 34%, P =.03) after implementation of the dose optimization program. The hazard ratio of developing CMV was 1.64 (95% CI 1.06-2.60, P =.027) for the pre-implementation group after adjusting for potential confounders. The program also resulted in a numerical reduction in the number of ganciclovir-resistant CMV cases (2 [0.7%] pre-implementation vs 0 post-implementation). Conclusions: An EHR-based, pharmacist-driven valganciclovir dose optimization program was associated with reduction in CMV infections.

AB - Background: Prophylaxis with valganciclovir reduces the incidence of cytomegalovirus (CMV) infection following solid organ transplant (SOT). Under-dosing of valganciclovir is associated with an increased risk of CMV infection and development of ganciclovir-resistant CMV. Methods: An automated electronic health record (EHR)-based, pharmacist-driven program was developed to optimize dosing of valganciclovir in solid organ transplant recipients at a large transplant center. Two cohorts of kidney, pancreas-kidney, and liver transplant recipients from our center pre-implementation (April 2011-March 2012, n = 303) and post-implementation of the optimization program (September 2012-August 2013, n=263) had demographic and key outcomes data collected for 1 year post-transplant. Results: The 1-year incidence of CMV infection dropped from 56 (18.5%) to 32 (12.2%, P =.05) and the incidence of breakthrough infections on prophylaxis was cut in half (61% vs 34%, P =.03) after implementation of the dose optimization program. The hazard ratio of developing CMV was 1.64 (95% CI 1.06-2.60, P =.027) for the pre-implementation group after adjusting for potential confounders. The program also resulted in a numerical reduction in the number of ganciclovir-resistant CMV cases (2 [0.7%] pre-implementation vs 0 post-implementation). Conclusions: An EHR-based, pharmacist-driven valganciclovir dose optimization program was associated with reduction in CMV infections.

KW - cytomegalovirus

KW - opportunistic infection

KW - prophylaxis

KW - valganciclovir

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DO - 10.1111/tid.12849

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