Elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) is a highly effective therapy for patients with cystic fibrosis (CF) with potential benefits in lung transplant recipients (LTRs) for extrapulmonary CF manifestations such as sinus disease, gastrointestinal disease, weight loss, and pancreatic insufficiency. Although the primary endpoint of approval studies was pulmonary function, non-pulmonary benefits reported with ELX/TEZ/IVA include weight gain, improvement in sinus disease, and improvements in pancreatic insufficiency,

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Intrapatient variability (IPV) of tacrolimus has become a marker for predicting transplant outcomes, though minimal data exists regarding strategies to improve tacrolimus IPV. Following the implementation of comprehensive outpatient clinical pharmacy services, the impact of a dedicated lung transplant pharmacist on 1-year tacrolimus variability and clinical outcomes in lung transplant recipients (LTRs) were investigated. A retrospective study of two LTR cohorts was conducted at a singlecenter institution. Cohort 1 included LTRs from January 1, 2015 to December 31, 2017 with tacrolimus dose adjustments made by physicians or nurse practitioners, and were seen by a pharmacist on an ad hoc basis. Cohort 2 included LTRs from January 1, 2018 to December 31, 2019 with tacrolimus adjustments made solely by a pharmacist who saw them at each routine visit with the multidisciplinary team for the first year post-transplant. The primary outcome assessed tacrolimus variability by the coefficient of variation 12 months post-transplant. Secondary outcomes assessed post-transplant hospital readmissions, acute cellular rejection (ACR), donor-specific antibodies (DSA), and mortality at 12 months post-transplant. No protocol changes occurred during the study period. Chi-squared and t-tests analyses were utilized. Sixty-three LTRs were included, 39 patients in Cohort 1 and 24 inCohort 2 with no significant differences between cohorts. At 1-year post-transplant, Cohort 2 had lower median tacrolimus variability (35.7% vs. 30.3%, p = 0.02) and more patients had a tacrolimus variability <30% (20.5% vs. 45.8%, p = 0.03). There were no differences in readmission rates, ACR, DSA, or mortality 12 months posttransplant. Based on this single-center limited cohort study, the integration of a dedicated ambulatory transplant pharmacist improved tacrolimus variability 1 year following lung transplant. Further studies are needed to assess long-term morbidity and mortality rates.