# Prospective evaluation of medication-related problems and pharmacist interventions in liver transplant recipients

## TL;DR

This study finds that medication issues are common in liver transplant patients, with dose and drug selection being key problems, and shows that comorbidities and kidney injury increase these risks.

## Contribution

This is the first comprehensive study applying PCNE v.9.1 to hospitalized liver transplant recipients in both ward and ICU settings.

## Key findings

- 311 out of 373 liver transplant recipients had at least one medication-related problem.
- Dose selection and drug selection were the leading causes of medication-related problems.
- Comorbidities and acute kidney injury were significant risk factors for medication-related problems.

## Abstract

Medication-related problems (MRPs) are a common patient safety issue among hospitalized individuals, often associated with reduced quality of life, increased healthcare costs, and higher mortality. Due to the chronic and complex nature of post-transplant care, liver transplant recipients are particularly vulnerable to MRPs. Clinical pharmacists play a critical role in identifying and resolving MRPs, thereby promoting the rational use of medications. The objective of this study was to characterize MRPs among liver transplant recipients and assess the clinical determinants associated with their occurrence.

This prospective study was conducted between 5 October 2023 to 31 April 2024 at the Liver Transplantation Institute. A total of 373 hospitalized liver transplant recipients in inpatient wards and intensive care units who were receiving at least one medication were included. Donors and patients not receiving any medication were excluded. The Pharmaceutical Care Network Europe (PCNE) classification system version 9.1 was used to categorize MRPs. Clinical and demographic characteristics of patients with and without MRPs were compared statistically and risk factors were analyzed through logistic regression.

Among the 373 patients included in this study, at least one MRP was identified in 311 patients, yielding 620 MRPs in total. A total of 620 interventions were proposed, of which 547 (88.2%) were accepted, while 73 (11.8%) were rejected. The leading causes of MRPs was “dose selection” (C3) was the most common cause (44.2%), followed by “drug selection” (C1) at 26.1%. The presence of at least one comorbidity and acute kidney injury were significant risk factors for the occurrence of MRPs (p < 0.05).

To our knowledge, this is the first and most comprehensive study applying the PCNE v.9.1 method to liver transplant recipients hospitalized in both ward and intensive care unit settings. The most prevalent MRPs were related to “treatment effectiveness,” primarily caused by “dose selection” and “drug selection.” Clinical pharmacists and physicians should particularly focus on these aspects when reviewing transplant patients’ medication regimens. The results achieved in this study suggest that clinicians should exercise caution when prescribing new medications to transplant recipients with at least one comorbidity and a history of acute kidney injury.