Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC 29425, USA.
Pharmacotherapy. 2012 Dec;32(12):1053-60. doi: 10.1002/phar.1145. Epub 2012 Nov 16.
To determine the incidence, risk factors, and clinical outcomes associated with clinically significant medication errors or adverse drug events in kidney transplant recipients.
Retrospective observational study.
Transplant center at an academic medical center.
A total of 476 adults who received kidney transplants between June 2006 and July 2009.
Severe or significant medication errors and adverse drug events (medication-related problems [MRPs]) were identified by medical record review. Only patient-induced medication errors (e.g., took wrong dose or frequency of drug, took drug not prescribed) were captured. Clinical outcomes included patient and graft survival, infections (including cytomegalovirus), readmissions, and acute rejection episodes. Thirty-seven (8%) of the 476 patients developed a clinically significant MRP. Univariate and confirmatory multivariate analyses revealed that female sex, African-American race, pretransplantation diabetes mellitus, delayed graft function, and retransplant recipients were independent risk factors for developing an MRP. Patients with MRPs had significantly higher rates of acute rejection (11% vs 30%, p=0.004), cytomegalovirus infection (15% vs 30%, p=0.033), and 30-day readmissions (5% vs 16%, p=0.018). Graft survival was also significantly lower in patients who had MRPs (p<0.001).
Patient-induced medication errors and associated adverse drug events were common in kidney transplant recipients. General and transplant-specific risk factors were associated with the development of these MRPs, and MRPs were associated with increased risk of rejection and graft loss.
确定肾移植受者中与临床显著药物错误或药物不良事件相关的发生率、风险因素和临床结局。
回顾性观察性研究。
学术医疗中心的移植中心。
2006 年 6 月至 2009 年 7 月期间共接受肾移植的 476 名成年人。
通过病历回顾确定严重或显著的药物错误和药物不良事件(药物相关问题[MRP])。仅捕获了由患者引起的药物错误(例如,服用了错误的剂量或药物频率,服用了未开的药物)。临床结局包括患者和移植物存活率、感染(包括巨细胞病毒)、再入院和急性排斥反应发作。476 名患者中有 37 名(8%)发生了临床显著的 MRP。单变量和验证性多变量分析显示,女性、非裔美国人种族、移植前糖尿病、延迟移植物功能和再次移植受者是发生 MRP 的独立危险因素。发生 MRP 的患者急性排斥反应(11%对 30%,p=0.004)、巨细胞病毒感染(15%对 30%,p=0.033)和 30 天再入院率(5%对 16%,p=0.018)显著更高。发生 MRP 的患者移植物存活率也显著降低(p<0.001)。
肾移植受者中患者引起的药物错误和相关药物不良事件很常见。一般和移植特异性危险因素与这些 MRP 的发生有关,MRP 与排斥反应和移植物丢失风险增加有关。