394 - Application of Pharmacogenomic Testing in Pediatric Kidney Transplant Patients

Publication Number: 3381.394

Benjamin Q. Duong, Nemours Children's Health, Boca Raton, FL, United States; Caroline Gluck, Nemours Children's Health, Wilmington, DE, United States; Susan M.. Kirwin, Nemours Children's Hospital, Wilmington, DE, United States; Ryan O'Leary, Nemours Children's Hospital, Wilmington, DE, United States; Nicole E. Tumolo, Nemours Children's Hospital, Wilmington, DE, United States; Nathan Seligson, Nemours Children's Health, Jacksonville, FL, United States

Background: Pediatric patients receiving kidney transplant require multiple medications to prevent organ rejection and manage comorbidities. Implementation of pharmacogenomic testing can identify patients at risk for gene-drug interaction related adverse events. Given the high use of medications with gene-drug interactions in patients receiving solid organ transplants, including immunosuppressive and supportive care medications, pharmacogenomic testing may have increased benefit in this population. Here, we report a pilot implementation of pharmacogenomic testing for patients receiving kidney transplant.

Objective: To describe the implementation of pharmacogenomic testing for pediatric patients receiving kidney transplant.

Design/Methods: A retrospective, single-center chart review was conducted for patients receiving or planning to receive kidney transplant referred to the Nemours Children’s Health Clinical Pharmacogenomics Service from January 2023 to October 2025. Data collected included clinical demographics, medication use, and pharmacogenomic testing results. Descriptive statistics were used as appropriate. Data was analyzed in Excel.

Results: Nineteen patients were consulted for pharmacogenomic testing (mean age 12.1 years, 63% male, 79% preemptive pharmacogenomic testing, 47% completed transplant). Before and after their kidney transplant, patients received an average of 2.67 and 3.3 medications with pharmacogenomic implications, respectively. Of the 9 consulted patients who received a kidney transplant, 100% were prescribed at least one drug with pharmacogenomic implications, including tacrolimus (100%, 9/9), ondansetron (100%, 9/9), proton pump inhibitors (67%, 6/9), selective serotonin reuptake inhibitors (33%, 3/9), azathioprine (11%, 1/9), or hydrocodone (11%, 1/9). Of patients who received a kidney transplant, 100% (9/9) had a theoretically actionable genotype of any kind while 44% (4/9) had at least one actionable genotype for a medication they were prescribed.

Conclusion(s): These findings highlight the potential impact of pharmacogenomic testing on treatment decision making in pediatric patients receiving or planning to receive a kidney transplant. While all patients that had a kidney transplant received at least one medication with pharmacogenomic implications and had a theoretically actionable genotype of any kind, almost half had an actionable genotype for a medication that they actually received. Pharmacogenomic testing may be a high-yield intervention for pediatric patients receiving kidney transplant. Future directions will quantitatively assess effects on clinical validity and utility outcomes.