{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T04:13:54Z","timestamp":1783743234135,"version":"3.55.0"},"reference-count":10,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Voriconazole is a triazole antifungal, primarily metabolized by the liver, and poses a dosing challenge in patients with liver impairment. Although the manufacturer recommends a maintenance dose reduction for mild\u2010to\u2010moderate hepatic dysfunction, no standardized recommendations exist for severe liver impairment. Prior evidence suggests a need for significant dose reduction in the setting of severe liver failure; however, there is limited data on empirical dosing in patients undergoing orthotopic liver transplant (OLT) evaluation and surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a single\u2010center, retrospective cohort study assessing voriconazole dosing and therapeutic drug monitoring (TDM) in patients with advanced cirrhosis who received voriconazole during urgent OLT evaluation and\/or surgery. Patients were included if voriconazole trough concentrations were collected at least 7\u2009days after therapy initiation pre\u2010OLT or at least 5\u2009days post\u2010OLT. The target therapeutic range was defined as 1\u20134 mcg\/mL. The primary outcome was the distribution of voriconazole trough concentrations in the pre\u2010 and post\u2010transplant cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The pre\u2010OLT cohort comprised 76 patients with 124 concentrations, and the post\u2010OLT cohort comprised 36 patients with 71 concentrations. As anticipated, the pre\u2010OLT group exhibited more abnormal liver enzymes and a high median Model for End\u2010Stage Liver Disease (MELD) score of 35 (Interquartile Range (IQR) 29.5\u201340). In the pre\u2010OLT setting, doses less than 2\u2009mg\/kg\/dose were more likely associated with therapeutic voriconazole concentrations. Supratherapeutic concentrations were observed in 41 patients (average dose of 2.4\u2009mg\/kg\/dose), of which five patients required therapy interruption. In the post\u2010OLT group, only 23 of 71 concentrations fell within the therapeutic range, with an average dose of 2.8\u2009mg\/kg\/dose.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We found that empiric voriconazole dosing in patients with advanced cirrhosis undergoing OLT evaluation should not exceed 2\u2009mg\/kg\/dose initially to mitigate the risk of drug accumulation and potential toxicity. In post\u2010OLT patients, it is reasonable to consider reverting to standard manufacturer\u2010recommended dosing. Given the pharmacokinetic variability observed, TDM is essential for effective and safe management in this high\u2010risk patient population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/phar.70176","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T05:00:56Z","timestamp":1781154056000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Voriconazole Dosing and Therapeutic Drug Monitoring in Patients Before and After Liver Transplantation"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1180-021X","authenticated-orcid":false,"given":"Wesley J.","family":"Hoffmann","sequence":"first","affiliation":[{"name":"Department of Pharmacy Houston Methodist Hospital  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6222-0829","authenticated-orcid":false,"given":"Shemual","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Houston Methodist Hospital  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9488-6997","authenticated-orcid":false,"given":"Luma","family":"Succar","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Houston Methodist Hospital  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8107-9735","authenticated-orcid":false,"given":"Aarjav","family":"Sanghvi","sequence":"additional","affiliation":[{"name":"Center for Health Data Science and Analytics Houston Methodist Hospital  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1106-171X","authenticated-orcid":false,"given":"Stephen L.","family":"Jones","sequence":"additional","affiliation":[{"name":"Center for Health Data Science and Analytics Houston Methodist Hospital  Houston Texas USA"},{"name":"Department of Surgery Weill Cornell Medical College  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7596-3771","authenticated-orcid":false,"given":"Ashton A.","family":"Connor","sequence":"additional","affiliation":[{"name":"Department of Surgery Weill Cornell Medical College  New York New York USA"},{"name":"Department of Surgery Houston Methodist Hospital  Houston Texas USA"},{"name":"J.C. Walter, Jr. Transplant Center Houston Methodist Hospital  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3925-4975","authenticated-orcid":false,"given":"Constance M.","family":"Mobley","sequence":"additional","affiliation":[{"name":"Department of Surgery Weill Cornell Medical College  New York New York USA"},{"name":"Department of Surgery Houston Methodist Hospital  Houston Texas USA"},{"name":"J.C. Walter, Jr. Transplant Center Houston Methodist Hospital  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6077-9595","authenticated-orcid":false,"given":"R. Mark","family":"Ghobrial","sequence":"additional","affiliation":[{"name":"Department of Surgery Weill Cornell Medical College  New York New York USA"},{"name":"Department of Surgery Houston Methodist Hospital  Houston Texas USA"},{"name":"J.C. Walter, Jr. Transplant Center Houston Methodist Hospital  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4898-1808","authenticated-orcid":false,"given":"Masayuki","family":"Nigo","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine Houston Methodist Hospital  Houston Texas USA"},{"name":"Center for Infectious Diseases Houston Methodist Research Institute  Houston Texas USA"},{"name":"Department of Medicine Weill Cornell Medical College  New York New York USA"},{"name":"McWilliams School of Biomedical Informatics University of Texas Health Science Center at Houston  Houston Texas USA"},{"name":"Division of Infectious Diseases University of Fukui  Fukui Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0091270008327537"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.XPHS.2019.09.019"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/PHAR.2474"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.IJID.2018.05.009"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics10091130"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01211-17"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00429\u201009"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.24365"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00626\u201012"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/phar.2850"}],"container-title":["Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/phar.70176","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/phar.70176","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/phar.70176","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T04:01:50Z","timestamp":1783742510000},"score":1,"resource":{"primary":{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/10.1002\/phar.70176"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,10]]},"references-count":10,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1002\/phar.70176"],"URL":"https:\/\/doi.org\/10.1002\/phar.70176","archive":["Portico"],"relation":{},"ISSN":["0277-0008","1875-9114"],"issn-type":[{"value":"0277-0008","type":"print"},{"value":"1875-9114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,10]]},"assertion":[{"value":"2026-01-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70176"}}