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A pharmacist-led intervention to improve kidney transplant recipient outcomes and identify patients at risk of highly variable trough tacrolimus levels: a cohort study
  1. Roxane Lhermitte1,
  2. Brendan Le Daré1,2,
  3. Florian Laval1,
  4. Florian Lemaitre3,
  5. Barbara Troussier1,
  6. Marie-Pascale Morin4,
  7. Cécile Vigneau5,
  8. Jonathan M Chemouny5,
  9. Astrid Bacle1,5
  1. 1 Service Hospitalo-Universitaire de Pharmacie, Rennes, France
  2. 2 NuMeCan, Rennes, France
  3. 3 Department of Clinical and Biological Pharmacology and Pharmacovigilance, Clinical Investigation Center CIC-P 1414, Rennes, France
  4. 4 Service de Néphrologie, CHU Rennes, Rennes, France
  5. 5 Univ Rennes, CHU Rennes, INSERM, EHESP, Irset-UMR_S 1085, 35000, Rennes, France, Rennes, France
  1. Correspondence to Astrid Bacle, Service Hospitalo-Universitaire de Pharmacie, Rennes 35000, France; astrid.bacle{at}


Objectives Given the positive impact of appropriate medication management on graft outcome and therefore of patient survival and graft function, the pharmacist’s role in the kidney transplantation team has evolved over recent decades. The primary objective of this study was to determine whether pharmacist-led intervention after kidney transplantation is associated with a lower graft rejection rate and intra-patient variation in tacrolimus trough concentrations (Cmin). The study’s secondary objective was to develop a questionnaire to identify patients at risk for highly variable Cmin.

Methods We retrospectively analysed kidney transplant recipients at Rennes University Hospital (France) between January 2013 and December 2020. Patients who received pharmacist-led education (intervention group, n=139) were compared with patients who did not (control group, n=131), according to graft survival at 1 year post-transplant, coefficient of variation (%CV) for the tacrolimus Cmin, age, sex, length of hospital stay post-transplantation, body mass index, and Charlson Comorbidity Index. In the intervention group, a questionnaire assessing patient knowledge was introduced to compare scores with the %CV.

Results In the intervention group, 1 year post-transplant graft survival was higher (95.7% vs 88.5%, p=0.0289) and patients had fewer variabilities in Cmin. The %CV was correlated with questionnaire scores (r=−0.9758, p<0.0001).

Conclusions Pharmacist-led interventions may have contributed to improved graft survival and patient management of immunosuppressants. Because %CV correlates with the patient questionnaire score, its introduction could be useful in identifying kidney transplant patients who would benefit most from a pharmacist-led patient education.

  • Clinical Competence
  • Drug Monitoring
  • Evidence-Based Medicine
  • Kidney Transplantation
  • Professional Competence

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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