Clinical and economic outcomes associated with medication errors in kidney transplantation.
OBJECTIVE
Modern immunosuppressant regimens have significantly decreased acute rejection rates, but may have increased the risk of graft loss driven by adverse drug reactions (ADRs) and medication errors (MEs). The objectives of this study were to determine the incidence and risk factors for MEs and ADRs and determine the association between transplant outcomes and these events.


METHODS
This was a post hoc analysis of a prospective, randomized trial that included patients aged>18 years that received a solitary renal transplant at an academic medical center recruited between March 2009 and July 2011. Patients were divided into groups based on developing a clinical significant ME (CSME), defined as a significant ME that contributed to a hospital admission.


RESULTS
The mean study follow-up was 2.5 ± 0.7 years. There were a total of 233 MEs and 327 ADRs in the 200 patients included in the analysis, with 64% of the cohort experiencing at least one ME and 87% experiencing an ADR; 23 patients (12%) experienced a CSME. Patients that experienced CSMEs had a trend toward more post-transplant readmissions (median 1 [interquartile range (IQR), 0-5] versus 0 [0-2]; P=0.06), higher costs for readmissions (median $18,091 [IQR, $3023-$56,268] versus $0 [$0-$15,991]; P<0.01), and overall length of stay (median 5.0 days [IQR, 2.0-14.0] versus 0.0 days [IQR, 0.0-5.5]; P<0.01) after the CSME event. CSME patients were also more likely to experience graft failure (22% versus 10%; P=0.05).


CONCLUSIONS
Significant MEs commonly occur in renal transplant recipients and are associated with an increased risk of deleterious clinical outcomes, including subsequent hospital days, costs, and graft loss.
Division of Transplant Surgery,, †Department of Pharmacy Services, and, ‡College of Nursing, Medical University of South Carolina, Charleston, South Carolina.
David J
DJ
Taber
Justin R
JR
Spivey
Victoria M
VM
Tsurutis
Nicole A
NA
Pilch
Holly B
HB
Meadows
James N
JN
Fleming
John W
JW
McGillicuddy
Charles F
CF
Bratton
Frank A
FA
Treiber
Prabhakar K
PK
Baliga
Kenneth D
KD
Chavin
D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000009:adverse effects*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000191:economics; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008508:Medication Errors / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
D000890:Anti-Infective Agents; D007166:Immunosuppressive Agents
acute rejection; drug interactions; drug nephrotoxicity; kidney transplantation