RISK FACTORS FOR DELAYED OR OMITTED TACROLIMUS IN KIDNEY TRANSPLANT RECIPIENTS DURING HOSPITAL ADMISSIONS – A SINGLE CENTRE STUDY
Dr GAYATHRI BIMAL1, Miss EMILY SCHEMBRI2, Mr JEFFRY VAN1, Dr MATTHEW ROBERTS1,2, Dr DARREN LEE1,2
1Department of Renal Medicine, Eastern Health, Melbourne, Australia, 2Eastern Health Clinical School, Monash University, Melbourne, Australia
Aim: To identify factors for delayed or omitted tacrolimus administrations in kidney transplant recipients (KTRs) during hospital admissions.
Background: While the importance of patient adherence to maintenance immunosuppression, particularly tacrolimus, is greatly emphasised in the community, the understanding of delayed or omitted immunosuppressant administration in KTRs during hospital admissions is lacking.
Methods: This is a single centre, retrospective study of KTRs admitted for at least 24 hours subsequent to their kidney transplant surgery admissions between January 2018 and June 2023 prescribed both tacrolimus and mycophenolate mofetil (MMF) or mycophenolic acid (MPA). Patient demographics, admission-related variables, scheduled and actual medication administration time were extracted from hospital electronic medical records. Doses were classified as on time, delayed (administration >60 minutes from scheduled dose) or omitted (administration failure prior to next scheduled dose). A two-level mixed effects-logistic regression model was used to identify factors associated with delayed/omitted administrations.
Results: There were 9515 total administrations of tacrolimus or MMF/MPA during a total of 561 hospital admissions to 162 KTRs, of which 14.5% (n=1382) were delayed (13.0%) or omitted (1.5%). Tacrolimus administrations were more likely delayed/omitted compared to MMF/MPA (aOR 1.41 (95%CI 1.24-1.60), p<0.001). Excluding MMF/MPA administrations, multivariable analysis identified non-nephrology ward (aOR 1.90 (95%CI 1.48-2.44), p<0.001) and extended-release (XL) formulation of tacrolimus (aOR 1.89 (95%CI 1.34-2.66), p<0.001) being associated with an increased risk of delayed/omitted tacrolimus doses. Evening doses (aOR 0.62 (95%CI 0.55-0.70), p<0.001) and weekend administrations (aOR 0.68 (95%CI 0.59-0.79), p<0.001) were associated with a lower risk.
Conclusions: Delayed/omitted tacrolimus administrations were not uncommon. Strategies to overcome medication-related and systemic risk factors should be identified. The unexpected protective effect of after-hours administrations requires further investigation.
Biography:
Gayathri is a BPT2 trainee at Eastern Health with a strong interest in nephrology and obstetric medicine with a focus on health service delivery and health equity.