Assessing pharmacologic and nonpharmacologic risks in candidates for kidney transplantation

• Published in: American journal of health-system pharmacy Vol. 72; no. 10; pp. 781 - 793
• Main Authors: Maldonado, Angela Q, Tichy, Eric M, Rogers, Christin C, Campara, Maya, Ensor, Christopher, Doligalski, Christina T, Gabardi, Steven, Descourouez, Jillian L, Doyle, Ian C, Trofe-Clark, Jennifer
• Format: Journal Article
• Language: English
• Published: England Copyright American Society of Health-System Pharmacists, Inc. All rights reserved 15.05.2015; Oxford University Press
• Subjects: Complications and side effects; Drug therapy; Graft Rejection - prevention & control; Humans; Kidney Transplantation; Medication Therapy Management; Postoperative complications; Risk Assessment; Risk factors; United States
• ISSN: 1079-2082; 1535-2900
• DOI: 10.2146/ajhp140476

PURPOSE.Pharmacotherapy concerns and other factors with a bearing on patient selection for kidney transplantation are discussed. SUMMARY.The process of selecting appropriate candidates for kidney transplantation involves multidisciplinary assessment to evaluate a patient’s mental, social, physical, financial, and medical readiness for successful surgery and good posttransplantation outcomes. Transplantation pharmacists can play important roles in the recognition and stratification of pharmacologic and nonpharmacologic risks in prospective kidney transplant recipients and the identification of issues that require a mitigation strategy. Key pharmacotherapy-related issues and considerations during the risk assessment process include (1) anticoagulation concerns, (2) cytochrome P-450 isoenzyme–mediated drug interactions, (3) mental health–related medication use, (4) chronic pain–related medication use, (5) medication allergies, (6) use of hormonal contraception and replacement therapy, (7) prior or current use of immunosuppressants, (8) issues with drug absorption, (9) alcohol use, (10) tobacco use, (11) active use of illicit substances, and (12) use of herbal supplements. Important areas of nonpharmacologic risk include vaccine delivery, infection prophylaxis and treatment, and socially related factors such as nonadherent behavior, communication barriers, and financial, insurance, or transportation challenges that can compromise posttransplantation outcomes. CONCLUSION.Consensus opinions of practitioners in transplantation pharmacy regarding the pharmacologic and nonpharmacologic factors that should be considered in assessing candidates for kidney transplantation are presented.