Date: Monday, June 3, 2019
Session Name: Poster Session C: Kidney: Cardiovascular and Metabolic
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Renal transplant recipients (RTRs) are at risk of developing post-transplant hyperglycemia (PTHG), defined as blood glucose > 180 mg/dL within the first 45 days post-transplant. RTRs undergo physiologic changes resulting in fluctuating blood glucose requirements due to increased renal elimination of insulin, steroid exposure, and calcineurin inhibitor related pancreatic beta cell injury. To provide targeted hyperglycemia management for RTRs, the transplant pharmacist’s (TP) role was expanded to include PTHG management. This study evaluates the impact of TPs on PTHG at our institution.
*Methods: A single center retrospective chart review was performed to evaluate TP’s management of PTHG in adult RTRs. Data was collected from January 2014 to August 2015 as a control. On September 2015, a collaborative drug therapy management protocol (CDTM) was created in collaboration with the transplant endocrinologist allowing TPs to start, modify, and discontinue anti-hyperglycemic agents based on this protocol. Patients who had two random blood glucoses ≥ 150 mg/dL or a value ≥ 180 mg/dL were referred by a provider to be seen by a TP. TPs followed RTRs via clinic visits and telephone encounters until the patient could be seen by an endocrinologist. Cohort data was collected from January 2016 to May 2017. The primary endpoint was hospitalization due to HG within 45 days. Secondary endpoints included hospitalizations with HG within 45 days and number of HG medications changes made for patients.
*Results: Patients in both cohorts had similar baseline characteristics (Table 1). Twenty four patients in the post-CDTM cohort were seen by TP for PTHG management. There was a statistically significant decrease in hospitalizations due to HG in the post-CDTM cohort (11 vs. 3, p=0.04) and no difference in hospitalizations with HG in the post-CDTM cohort (32 vs. 40, p=NS). Two hospitalizations that occurred in the post-CDTM cohort were not seen by TP for PTHG prior to readmission. On average, there were 2.3 + 1.1 interventions per patient in the pre-CDTM cohort compared to 3.0 + 2.5 interventions per patient in the post-CDTM cohort (p=NS).
*Conclusions: Transplant pharmacist engagement in PTHG management of RTR allows for reduced HG related hospitalizations.
|Pre-CDTM (n=100)||Post-CDTM (n=100)|
|DM History, %||48||43|
|Baseline Hgb A1c, mean||6.5||6.11|
To cite this abstract in AMA style:Do VH, Figueroa I, Elshafie A, Aguiar RBelfortDe, Haakinson D, Cohen E. Pharmacist-Led Management of Post-Transplant Hyperglycemia Reduces Hospitalizations [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/pharmacist-led-management-of-post-transplant-hyperglycemia-reduces-hospitalizations/. Accessed April 20, 2021.
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