Pharmacist Impact on Tacrolimus Serum Concentrations in Liver Transplant Patients.

Objective The purpose of this quality-improvement project was to determine if a pharmacist consultation following a liver transplant is associated with an increased percentage of drug levels in range after the patient sees the pharmacist. Setting Tertiary care, multispecialty medical clinic, and hospital providing solid-organ transplant. Practice Description Pharmacist consult service in a tertiary care, multispecialty medical clinic and hospital providing solid-organ transplant. Practice InnovationProvision of liver post-transplant consultations, not required by the Centers for Medicare & Medicaid Services, that results in therapeutic drug level improvement. Main Outcome MeasureTacrolimus therapeutic drug levels in range. Results A 96% improvement in quantity of therapeutic tacrolimus levels was seen in liver post-transplant patients after pharmacist post-transplant consultation. Results revealed 59 out of 74 (79.7%) post-liver transplant patients, 25 to 77 years of age (average 59.7 years), had an increased number of therapeutic tacrolimus levels after pharmacist post-transplant consultation. ConclusionWithout a pharmacist consultation following a liver transplant, patients may have a higher number of tacrolimus levels out of therapeutic range, placing them at increased risk for possible graft loss from low tacrolimus levels or toxicity resulting from high tacrolimus levels. Improvement in therapeutic tacrolimus levels after liver transplant was observed after patients received consultation and education from a clinical pharmacist. This finding creates an opportunity for pharmacists to implement services for patients after liver transplants to improve therapeutic tacrolimus levels.