Survey of the utilization of genotype-guided tacrolimus management in United States solid organ transplant centers.

Introduction: Genotype-guided tacrolimus management is not routine in clinical practice despite the availability of Clinical Pharmacogenetics Implementation Consortium dosing guidelines. Prior surveys have evaluated patient and provider perspectives of pharmacogenetics (PGx) in transplant, but limited recent data exists on tacrolimus PGx implementation across United States transplant centers.

Methods: An electronic survey was distributed to transplant pharmacists regarding utilization of tacrolimus PGx, methods of implementing PGx, and barriers to clinical implementation. A survey response was requested for each organ program within the transplant center.

Results: A total of 90 programs from 69 transplant centers (28.1% of active U.S. transplant centers) responded to the survey. Tacrolimus PGx was utilized for patient care in 14 programs (15.6%). There was substantial variability in the implementation methods and application of tacrolimus PGx results among transplant programs. In programs that had not implemented tacrolimus PGx, common barriers for implementation included PGx testing cost and availability and lack of evidence for clinical utility.

Conclusion: Implementation of PGx guided tacrolimus in solid organ transplant centers remains limited with heterogeneity in the implementation approach. Additional research is needed to establish the clinical utility of PGx guided tacrolimus and education on reimbursement and testing resources may help to increase uptake.