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 journalArticlepeer-review

6 Scopus citations

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 2018

Keywords

  • cytomegalovirus
  • opportunistic infection
  • prophylaxis
  • valganciclovir

ASJC Scopus subject areas

  • Infectious Diseases
  • Transplantation

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