Dried Blood Spot Monitoring After Lung Transplantation: Patients Perspectives

M.J.C. Wessels-Bakker, E.M. van Maarseveen, M.E. Janssen, H.D. Luijk, E.A. van de Graaf, A.C. Egas, J.M. Kwakkel-van Erp

Chair(s): M.J.C. Wessels & J.M. Wierdsma

Thursday 9 march 2017

9:36 - 9:48h at Willem Pijperzaal

Categories: Parallel - Verpleegkundig

Parallel session: Parallelsessie X – Verpleegkundig

After lung transplantation lifetime drug monitoring of the immunosuppressive drug tacrolimus is necessary because of a narrow therapeutic window and large inter- and intra-individual variability of the tacrolimus blood concentration. Since 2012 the dried bloodspot (DBS) testing of tacrolimus was introduced in our daily clinical practice in stable outpatient lung transplant recipients. The aim of this study was to evaluate patient satisfaction of DBS sampling. Methods: 39 stable lung transplant recipients at our center were recruited for the evaluation of the DBS testing. Patients with scleroderma were excluded. Patient satisfaction was evaluated using a written questionnaire 6 to 12 months after starting DBS. Eighty-two percent (32/39) of the patients responded. Two of the 32 patients admitted they never used the DBS and were therefore excluded. Native lung disease of the 7 non-responders was Cystic Fibrosis (86%) or Pulmonary Hemosiderosis (14%). Forty-three percent was male (median age 30 years; range 23-52). Native lung disease of the 30 responders was Cystic Fibrosis (77%), COPD (10%) and approximately 3% was A1ATD, sarcoidosis, IPF or Pulmonary Hypertension. Fifty percent of the responders was male (median age 32 years; range 21-64). On a scale from 0 to 10, patient satisfaction was 8.3 (range 2,5-10). Hundred percent of the patients were content with the patient information and the instruction. None of the responders experienced any inconvenience with the finger prick and all of them continued the DBS. Twenty-seven responders reported difficulties with applying the blood drop on the sampling paper because of tremors caused by tacrolimus. However, almost all bloodspot samples sent to our laboratory were valid. Finally, 40% percent of the responders reported that they would like to have an e-reminder to send the DBS sample in time. 

Conclusion:
Patient satisfaction with DBS method was high in our outpatient population. DBS testing of tacrolimus is considered patient friendly. DBS sampling of tacrolimus can be performed at home and can reduce the outpatient clinic visits. All patients continued to use the DBS. Home sampling is a promising tool to improve quality of life for lung transplantation patients.