ORIGINAL RESEARCH article
Front. Immunol.
Sec. Alloimmunity and Transplantation
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1553786
This article is part of the Research TopicClinical Pharmacist Service Promotes the Improvement of Medical Quality Volume IIView all 53 articles
The Impact of Pharmacists' Interventions Within the Closed Loop Immunosuppressant Management Process on Kidney Transplant Recipients: A Retrospective Cohort Study
Provisionally accepted
- People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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Introduction: Nowadays, kidney transplant recipients' primary challenge is improving graft function. However, they are rarely provided effective long-term instructions on immunosuppressant use after transplant. This study aimed to describe the experiences of a pharmacist-led, closed-loop immunosuppressant service (PLIS) in the transplant center of a general hospital in China.A retrospective pre-and post-intervention study was conducted in the transplantation department in a general hospital. Of the 347 patients receiving kidney transplants from August 2022 to August 2024 were enrolled. Eligible subjects were assigned into two groups (pre-intervention group and post-intervention group) according to the date ( 1August 2023) when the pharmacist commenced participation in the post-transplant management for kidney transplant recipients. The intra-patient variation in immunosuppressant trough concentrations (Cmin) before and after the intervention was defined as the primary outcome. The secondary outcome was to assess the impact on renal function.Results: Among 347 patients (August 2022-2024), those managed post-intervention (from August 2023) showed improved target trough concentration (Cmin) attainment versus preintervention: tacrolimus (TAC, 72.4% vs. 58.3%, P=0.012), cyclosporine (CsA, 63.7% vs. 46.5%, P=0.037), mycophenolate (MMF, 76.0% vs. 65.3%, P=0.025), and sirolimus (SRL, 80.2% vs. 51.9%, P=0.018). Compared to pre-intervention, the percentage coefficient of variation (%CV) decreased significantly for TAC (18.28% vs. 8.92%, P=0.031) and CsA (22.97% vs. 7.14%, P=0.004) post-intervention, while MMF maintained high variability (CV >30%).SRL variability declined at 6-12 months (17.02% vs. 26.05%, P=0.194). Renal function improved post-intervention, with reductions in serum creatinine, urea nitrogen, cystatin C, and microproteinuria (P<0.05).PLIS enhanced immunosuppressant management precision and graft outcomes, demonstrating its utility in standardizing post-transplant care.
Keywords: Immunosuppression therapy, immunosuppressant management, Transplantation, Pharmacists, clinical practice
Received: 31 Dec 2024; Accepted: 19 Aug 2025.
Copyright: © 2025 Chen, Ou, Li and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Hongxia Chen, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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