2026 Eastern States Conference

Authors: Victor E. Rojas Velazquez, Pharm.D., Rachel Savilla, Pharm.D., Nicole McCoy, Pharm.D., Safiyyah Mitchell, Pharm.D., Brian Burton, MS
Learning Objective: Identify areas where clinical pharmacists can serve a critical role in CMV prophylaxis dosing adjustments and rationale
Background/Objective: Studies have shown that pharmacist implementation can lead to minimization of adverse events in immunosuppression management. The aim of this study was to evaluate the impact of an outpatient transplant pharmacist on CMV prophylaxis appropriateness.
Methods: Medical records were reviewed as a retrospective cohort study of kidney transplant recipients at Charleston Area Medical Center between January 2024 and June 2025. Comparing outcomes before and after implementing a pharmacist-led intervention, stratification of cohorts was decided by initiation date of clinical pharmacist. Data collected consisted of renal function to assess appropriateness of CMV prophylaxis dosing, incidence of breakthrough CMV, other infections, bacteremia, graft, and patient survival using data up to 3 months post-transplant.
Results: CMV appropriateness was assessed for 76% of the 128 patients studied. A greater portion of patients were included in the control arm compared to the treatment arm (n = 59 versus 39). Statistical analysis for the appropriateness of renal dose adjustments between the two cohorts detected no difference when viewed from discharge up to 3 months post-transplant. Unexpectedly, renal dose adjustments between the cohorts during discharge showed statistical significance towards the control (0 versus 12.82% inappropriately adjusted, p = 0.0089). Secondary outcomes such as bacteremia (p = 0.4), other infections (p = 0.7) biopsy proven rejection (p = 0.4) showed no difference.
Conclusions: Lack of statistical significance for appropriate renal dose adjustments shown is likely due to limitations of retrospective analysis rather than lack of clinical significance. Statistical significance of the patients captured at discharge was attributed to multiple factors that were not accounted for during data analysis. Nonetheless, a positive trend for appropriate renal dose adjustments favored the post-pharmacist group, signifying potential benefit of the clinical pharmacist’s role.
Self- assessment question: What gaps can clinical transplant pharmacist focus on to avoid potential unwanted effects of non-renally dose adjusted valganciclovir?