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Patients receiving immunosuppressive drugs – essential reading.

Patients receiving immunosuppressive drugs – essential reading.

Repatriation means the return of patients to transplant specialist centers in terms of the prescribing (instead of their GP) of their immunosuppressive drugs.


There is a variance in arrangements for the prescribing and funding of immunosuppression medication throughout England. The Renal Transplant Clinical Reference Group (CRG) recommend that all patients receiving post-transplant immunosuppressive drugs (ISD’s) should be managed directly by the specialist centre and those patients receiving their ISD’s from GPs should be repatriated. Currently NHS England are working on this change initiative.

NHS England anticipated that agreed processes would be in place by April 2014 with the intention that all post-transplant patients will be receiving their medication from their specialist center by April 2015. THIS TIMESCALE HAS NOT BEEN ACHIEVED AND THE CHANGE IS ONGOING

Some areas of England have already implemented repatriation and/or have agreed implementation dates. To reduce the impact to patients, medication will be provided via homecare and/or throughout-sourced delivery systems allowing collection of prescription close to the patient’s home. HOWEVER HOMECARE SERVICES HAVE EXPERINCED DIFFICULTY THEMSELVES please see the Alert Message on the NKF website.

 The drugs that covered are:

• Azathioprine

• Prednisolone

• Ciclosporin

• Tacrolimus

• Mycophenolate Mofetil

• Mycophenolate Sodium

• Sirolimus


Patient safety is a key driver for this initiative. Current safety and quality concerns include the inadvertent switch between brands of Tacrolimus and Ciclosporin, which can lead to clinically significant negative outcomes such as toxicity and rejection. There is limited knowledge in primary care around medicines management for renal transplant patients. On occasions this has led to inappropriate/too frequent or infrequent patient monitoring and failure to identify unwanted effects of ISD’s and clinically significant interactions with other medicines and foods. Repatriation of prescribing of post-transplant ISD’s to secondary care will minimise the risk of inappropriate brand switching and allow for greater specialist medicines management. After repatriation GPs will continue to have an active role in prescribing for transplant patients, including the prescribing of all other drugs the patient may require. It is therefore vital that excellent communication between secondary and primary care exists. Both parties need to be kept fully informed of patients’ medication regimen to support safe prescribing. In addition to improving the value of renal transplant services through improved patient quality and safety, repatriation offers a significant opportunity to achieve potential savings by utilising secondary care contract drug prices.