2020 · British journal of clinical pharmacology · open access
Effects, costs and implementation of monitoring kidney transplant patients' tacrolimus levels with dried blood spot sampling: A randomized controlled hybrid implementation trial
Veenhof et al.
The finding, in our words
In adult kidney transplant patients, adding DBS home sampling to usual care did not reduce outpatient visits or per-visit costs versus usual care alone, though most patients were willing to use DBS if it cut hospital attendances; logistical optimisation of mailing and timely analysis is required to realise travel and cost benefits.
A paraphrase to the Library’s standard, never the abstract. The source is one link away and is always the authority.
This review surveys published LC-MS/MS methods that use dried blood microsampling for therapeutic drug monitoring of immunosuppressants in transplantation, chemotherapy and autoimmune disease, finding that volumetric dried blood samples can replace conventional venous draws for home sampling and improve patient quality of life. The authors discuss pre-analytical considerations, clinical applicability, cost-effectiveness, harmonisation gaps and patient perception, concluding that obstacles to routine clinical implementation remain despite growing methodological maturity.
The study found that quantitative dried blood spot sampling provided high clinical agreement for tacrolimus and creatinine monitoring, with patients rating the self-collection devices as user-friendly. These results support the feasibility of decentralised therapeutic drug monitoring for immunosuppressants.
A systematic review found mixed economic evidence for microsampling in therapeutic drug monitoring; one study reported no cost reduction with DBS home-sampling, €688 versus €676, whilst another predicted savings up to 61%. The authors caution that more work is required to assess costs alongside clinical outcomes and optimise logistics for decentralised implementation.
The study determined that using self-collected dried blood spots alongside online surveys was a feasible and acceptable method for remote pre-exposure prophylaxis adherence monitoring, with 64% of participants returning at least one blood specimen.
This systematic review of 67 studies involving 34,739 kidney disease patients found dried blood microsampling was mainly used for immunosuppressant therapeutic drug monitoring and kidney function assessment. The approach offered cost savings, was preferred by patients for home self-collection, and provides a patient-centric opportunity to upscale longitudinal sampling and reduce participation bias in decentralised kidney disease research.