Assessing pharmacologic and nonpharmacologic risks in candidates for kidney transplantation.
OBJECTIVE
Pharmacotherapy concerns and other factors with a bearing on patient selection for kidney transplantation are discussed.


CONCLUSIONS
The process of selecting appropriate candidates for kidney transplantation involves multidisciplinary assessment to evaluate a patient's mental, social, physical, financial, and medical readiness for successful surgery and good posttransplantation outcomes. Transplantation pharmacists can play important roles in the recognition and stratification of pharmacologic and nonpharmacologic risks in prospective kidney transplant recipients and the identification of issues that require a mitigation strategy. Key pharmacotherapy-related issues and considerations during the risk assessment process include (1) anticoagulation concerns, (2) cytochrome P-450 isoenzyme-mediated drug interactions, (3) mental health-related medication use, (4) chronic pain-related medication use, (5) medication allergies, (6) use of hormonal contraception and replacement therapy, (7) prior or current use of immunosuppressants, (8) issues with drug absorption, (9) alcohol use, (10) tobacco use, (11) active use of illicit substances, and (12) use of herbal supplements. Important areas of nonpharmacologic risk include vaccine delivery, infection prophylaxis and treatment, and socially related factors such as nonadherent behavior, communication barriers, and financial, insurance, or transportation challenges that can compromise posttransplantation outcomes.


CONCLUSIONS
Consensus opinions of practitioners in transplantation pharmacy regarding the pharmacologic and nonpharmacologic factors that should be considered in assessing candidates for kidney transplantation are presented.
Angela Q. Maldonado, Pharm.D., BCPS, CPP, is Clinical Pharmacy Specialist, Department of Transplant Surgery, Vidant Medical Center, Greenville, NC. Eric M. Tichy, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT. Christin C. Rogers, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Coordinator, Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA. MayaCampara, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, University of Illinois at Chicago. ChristopherEnsor, Pharm.D., BCPS, is Clinical Pharmacy Specialist, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. ChristinaT. Doligalski, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, Tampa General Hospital, Tampa, FL. Steven Gabardi, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Departments of Transplant Surgery and Pharmacy and Renal Division, Brigham and Women's Hospital, Boston, MA. JillianL. Descourouez, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison. Ian C. Doyle, Pharm.D., BCPS, is Assistant Professor, School of Pharmacy, Pacific University, Hillsboro, OR. JenniferTrofe-Clark, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, and Adjunct Associate Professor, Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania. angela.maldonado@vidanthealth.com.
Angela Q
AQ
Maldonado
Angela Q. Maldonado, Pharm.D., BCPS, CPP, is Clinical Pharmacy Specialist, Department of Transplant Surgery, Vidant Medical Center, Greenville, NC. Eric M. Tichy, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT. Christin C. Rogers, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Coordinator, Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA. MayaCampara, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, University of Illinois at Chicago. ChristopherEnsor, Pharm.D., BCPS, is Clinical Pharmacy Specialist, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. ChristinaT. Doligalski, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, Tampa General Hospital, Tampa, FL. Steven Gabardi, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Departments of Transplant Surgery and Pharmacy and Renal Division, Brigham and Women's Hospital, Boston, MA. JillianL. Descourouez, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison. Ian C. Doyle, Pharm.D., BCPS, is Assistant Professor, School of Pharmacy, Pacific University, Hillsboro, OR. JenniferTrofe-Clark, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, and Adjunct Associate Professor, Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania.
Eric M
EM
Tichy
Angela Q. Maldonado, Pharm.D., BCPS, CPP, is Clinical Pharmacy Specialist, Department of Transplant Surgery, Vidant Medical Center, Greenville, NC. Eric M. Tichy, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT. Christin C. Rogers, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Coordinator, Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA. MayaCampara, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, University of Illinois at Chicago. ChristopherEnsor, Pharm.D., BCPS, is Clinical Pharmacy Specialist, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. ChristinaT. Doligalski, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, Tampa General Hospital, Tampa, FL. Steven Gabardi, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Departments of Transplant Surgery and Pharmacy and Renal Division, Brigham and Women's Hospital, Boston, MA. JillianL. Descourouez, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison. Ian C. Doyle, Pharm.D., BCPS, is Assistant Professor, School of Pharmacy, Pacific University, Hillsboro, OR. JenniferTrofe-Clark, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, and Adjunct Associate Professor, Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania.
Christin C
CC
Rogers
Angela Q. Maldonado, Pharm.D., BCPS, CPP, is Clinical Pharmacy Specialist, Department of Transplant Surgery, Vidant Medical Center, Greenville, NC. Eric M. Tichy, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT. Christin C. Rogers, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Coordinator, Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA. MayaCampara, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, University of Illinois at Chicago. ChristopherEnsor, Pharm.D., BCPS, is Clinical Pharmacy Specialist, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. ChristinaT. Doligalski, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, Tampa General Hospital, Tampa, FL. Steven Gabardi, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Departments of Transplant Surgery and Pharmacy and Renal Division, Brigham and Women's Hospital, Boston, MA. JillianL. Descourouez, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison. Ian C. Doyle, Pharm.D., BCPS, is Assistant Professor, School of Pharmacy, Pacific University, Hillsboro, OR. JenniferTrofe-Clark, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, and Adjunct Associate Professor, Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania.
Maya
M
Campara
Angela Q. Maldonado, Pharm.D., BCPS, CPP, is Clinical Pharmacy Specialist, Department of Transplant Surgery, Vidant Medical Center, Greenville, NC. Eric M. Tichy, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT. Christin C. Rogers, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Coordinator, Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA. MayaCampara, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, University of Illinois at Chicago. ChristopherEnsor, Pharm.D., BCPS, is Clinical Pharmacy Specialist, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. ChristinaT. Doligalski, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, Tampa General Hospital, Tampa, FL. Steven Gabardi, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Departments of Transplant Surgery and Pharmacy and Renal Division, Brigham and Women's Hospital, Boston, MA. JillianL. Descourouez, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison. Ian C. Doyle, Pharm.D., BCPS, is Assistant Professor, School of Pharmacy, Pacific University, Hillsboro, OR. JenniferTrofe-Clark, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, and Adjunct Associate Professor, Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania.
Christopher
C
Ensor
Angela Q. Maldonado, Pharm.D., BCPS, CPP, is Clinical Pharmacy Specialist, Department of Transplant Surgery, Vidant Medical Center, Greenville, NC. Eric M. Tichy, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT. Christin C. Rogers, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Coordinator, Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA. MayaCampara, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, University of Illinois at Chicago. ChristopherEnsor, Pharm.D., BCPS, is Clinical Pharmacy Specialist, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. ChristinaT. Doligalski, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, Tampa General Hospital, Tampa, FL. Steven Gabardi, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Departments of Transplant Surgery and Pharmacy and Renal Division, Brigham and Women's Hospital, Boston, MA. JillianL. Descourouez, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison. Ian C. Doyle, Pharm.D., BCPS, is Assistant Professor, School of Pharmacy, Pacific University, Hillsboro, OR. JenniferTrofe-Clark, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, and Adjunct Associate Professor, Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania.
Christina T
CT
Doligalski
Angela Q. Maldonado, Pharm.D., BCPS, CPP, is Clinical Pharmacy Specialist, Department of Transplant Surgery, Vidant Medical Center, Greenville, NC. Eric M. Tichy, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT. Christin C. Rogers, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Coordinator, Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA. MayaCampara, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, University of Illinois at Chicago. ChristopherEnsor, Pharm.D., BCPS, is Clinical Pharmacy Specialist, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. ChristinaT. Doligalski, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, Tampa General Hospital, Tampa, FL. Steven Gabardi, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Departments of Transplant Surgery and Pharmacy and Renal Division, Brigham and Women's Hospital, Boston, MA. JillianL. Descourouez, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison. Ian C. Doyle, Pharm.D., BCPS, is Assistant Professor, School of Pharmacy, Pacific University, Hillsboro, OR. JenniferTrofe-Clark, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, and Adjunct Associate Professor, Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania.
Steven
S
Gabardi
Angela Q. Maldonado, Pharm.D., BCPS, CPP, is Clinical Pharmacy Specialist, Department of Transplant Surgery, Vidant Medical Center, Greenville, NC. Eric M. Tichy, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT. Christin C. Rogers, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Coordinator, Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA. MayaCampara, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, University of Illinois at Chicago. ChristopherEnsor, Pharm.D., BCPS, is Clinical Pharmacy Specialist, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. ChristinaT. Doligalski, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, Tampa General Hospital, Tampa, FL. Steven Gabardi, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Departments of Transplant Surgery and Pharmacy and Renal Division, Brigham and Women's Hospital, Boston, MA. JillianL. Descourouez, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison. Ian C. Doyle, Pharm.D., BCPS, is Assistant Professor, School of Pharmacy, Pacific University, Hillsboro, OR. JenniferTrofe-Clark, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, and Adjunct Associate Professor, Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania.
Jillian L
JL
Descourouez
Angela Q. Maldonado, Pharm.D., BCPS, CPP, is Clinical Pharmacy Specialist, Department of Transplant Surgery, Vidant Medical Center, Greenville, NC. Eric M. Tichy, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT. Christin C. Rogers, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Coordinator, Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA. MayaCampara, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, University of Illinois at Chicago. ChristopherEnsor, Pharm.D., BCPS, is Clinical Pharmacy Specialist, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. ChristinaT. Doligalski, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, Tampa General Hospital, Tampa, FL. Steven Gabardi, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Departments of Transplant Surgery and Pharmacy and Renal Division, Brigham and Women's Hospital, Boston, MA. JillianL. Descourouez, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison. Ian C. Doyle, Pharm.D., BCPS, is Assistant Professor, School of Pharmacy, Pacific University, Hillsboro, OR. JenniferTrofe-Clark, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, and Adjunct Associate Professor, Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania.
Ian C
IC
Doyle
Angela Q. Maldonado, Pharm.D., BCPS, CPP, is Clinical Pharmacy Specialist, Department of Transplant Surgery, Vidant Medical Center, Greenville, NC. Eric M. Tichy, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT. Christin C. Rogers, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Coordinator, Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA. MayaCampara, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, University of Illinois at Chicago. ChristopherEnsor, Pharm.D., BCPS, is Clinical Pharmacy Specialist, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA. ChristinaT. Doligalski, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, Tampa General Hospital, Tampa, FL. Steven Gabardi, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Departments of Transplant Surgery and Pharmacy and Renal Division, Brigham and Women's Hospital, Boston, MA. JillianL. Descourouez, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison. Ian C. Doyle, Pharm.D., BCPS, is Assistant Professor, School of Pharmacy, Pacific University, Hillsboro, OR. JenniferTrofe-Clark, Pharm.D., FCCP, BCPS, is Clinical Pharmacy Specialist, Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, and Adjunct Associate Professor, Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania.
Jennifer
J
Trofe-Clark
D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D016030:Kidney Transplantation; D054539:Medication Therapy Management; D018570:Risk Assessment