Original Research
Tuesday, October 15, 2024
08:30 AM–10:00 AM
Abstract
Introduction: Despite the recommendations published by CPIC in 2015,
CYP3A5 genotype-guided tacrolimus management has not been incorporated into routine clinical practice. While several studies have described the patient and provider perspective, limited data exists on the current state of clinical implementation of tacrolimus pharmacogenomics (PGx) at the transplant center level across the United States (US).
Research Question or Hypothesis: What are characteristics of tacrolimus PGx in the US transplant programs and what barriers prevented clinical implantation of tacrolimus PGx?
Study Design: Survey of US transplant centers
Methods: A 33-question electronic survey was distributed to the American College of Clinical Pharmacy Transplant Practice & Research Network and the American Society of Transplantation Transplant Pharmacy Community of Practice listservs between 1/22/24-2/19/24. Pharmacist members were asked to complete questions regarding utilization of tacrolimus PGx in adult/pediatric heart, lung, kidney, and pancreas transplant programs at their center and perceived barriers to clinical implementation of tacrolimus PGx. Descriptive statistics summarized the responses.
Results: A total of 90 programs from 69 transplant centers (28.1% of 245 active US transplant centers) were included. Tacrolimus PGx was utilized for patient care in 14 programs (15.6%), primarily in adult kidney and heart transplant. Eleven had PGx pharmacist support. For PGx testing, a multi-gene panel was used by 8, an external lab was used by 7, and cost was billed to insurance/patient by 7. Only 3 programs had protocolized PGx-based tacrolimus dosing versus 6 where dosing was determined by individual clinicians. Only 1 incorporated clinical decision support for recommendation versus 9 that used verbal/written communication. The perceived barriers for clinical implementation included PGx testing cost and availability, lack of evidence to support benefit, and lack of transplant-specific guideline recommendation for PGx testing.
Conclusion: There is a need for increased education and development of effective strategies to overcome the barriers for clinical implementation of tacrolimus PGx across the US transplant centers.
Presenting Author
Ashton Strother PharmDUniversity of Michigan Health
Authors
Jeong Park PharmD, MS
University of Michigan, College of Pharmacy
Amy Pasternak PharmD
University of Michigan College of Pharmacy