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Amy L Pasternak,1 Vincent D Marshall,1 Christina L Gersch,2 James M Rae,2 Michael Englesbe,3 Jeong M Park1 1Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, 48109, USA; 2Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, 48109, USA; 3Department of Surgery, Michigan Medicine, Ann Arbor, MI, 48109, USACorrespondence: Amy L Pasternak Email amylp@med.umich.eduPurpose: CYP3A5 genotype is a significant contributor to inter-individual tacrolimus exposure and may impact the time required to achieve therapeutic concentrations and number of tacrolimus dose adjustments in transplant patients. Increased modifications to tacrolimus therapy may indicate a higher burden on healthcare resources. The purpose of this study was to evaluate whether CYP3A5 genotype was predictive of healthcare resource utilization in pediatric renal and heart transplant recipients.Patients and Methods: Patients < 18 years of age with a renal or heart transplant between 6/1/2014– 12/31/2018 and tacrolimus-based immunosuppression were included. Secondary use samples were obtained for CYP3A5 genotyping. Clinical data was retrospectively collected from the electronic medical record. Healthcare resource utilization measures included the number of dose changes, number of tacrolimus concentrations, length of stay, number of clinical encounters, and total charges within the first year post-transplant. Rejection and donor-specific antibody (DSA) formation within the first year were also collected. The impact of CYP3A5 genotype was evaluated via univariate analysis for the first year and multivariable analysis at 30, 90, 180, 270, and 365 days post-transplant.Results: Eighty-five subjects were included, 48 renal transplant recipients and 37 heart transplant recipients. CYP3A5 genotype was not associated with any outcomes in renal transplant, however, a CYP3A5 expresser phenotype was a predictor of more dose changes, more tacrolimus concentrations, longer length of stay, and higher total charges in heart transplant recipients. CYP3A5 genotype was not associated with rejection or DSA formation. Age and induction therapy were associated with higher total charges.Conclusion: CYP3A5 genotype may predict healthcare resource utilization in the first year post-transplant, although this may be mitigated by differences in tacrolimus management. Future studies should evaluate the impact of genotype-guided dosing strategies for tacrolimus on healthcare utilization resources.Keywords: pharmacogenetics, cost of care, pediatric transplant

Objective: Venous thromboembolism (VTE) is a major cause of morbidity and mortality in hospitalized patients, particularly surgical patients. We hypothesize that PAs are well-positioned to assist health systems with implementation of efforts to reduce the rates of this in-hospital complication and increase adherence to published standards for VTE prophylaxis. Methods: We conducted a retrospective cohort study of general surgical patients who underwent an operation at the University of Michigan between July 2005 and June 2007. The PAs in the Department of Surgery implemented a VTE assessment and prophylaxis intervention in June 2006. Preintervention VTE risk scores were calculated using patient demographic information, operating room data. and diagnosis codes from the International Statistical Classification of Diseases, Ninth Revision. Clinical Modification (lCD-9-CM). Those calculated scores were then tested on patients who had a VTE risk score documented by PAs. Postintervention VTE was determined using ICD-9-CM diagnosis codes for deep vein thrombosis (DVT) or pulmonary embolism (PE) and identified as 'acquired in hospital' or readmitted with a principal diagnosis of DVT or PE within 30 days following surgery. We then compared the frequency with which patients in the preintervention and postintervention periods received recommended VTE prophylaxis. Results: Overall, 2,046 patients underwent surgery during the study period. There were 1,079 patients in the preintervention group and 967 patients in the postintervention group, with no systematic differences in the case mix between the two groups. For all patients with a risk score of 3 or higher (indicating high and highest risk combined), orders for appropriate prophylaxis improved from an average of 23.1% in the preintervention group to an average of 63.7% in the postintervention group. Similarly, for all patients with a risk score of 5 or higher (indicating highest risk), orders for appropriate prophylaxis improved from an average of 29.4% in the preintervention group to an average of 69.5% in the postintervention group. Conclusions: Through a PA-driven VTE risk assessment process, we dramatically increased the number of patients within our health system who were prescribed appropriate orders for VTE prophylaxis according to published guidelines and according to individual patient risk. [ABSTRACT FROM AUTHOR]