Interview with Ofelia Noceti, National Center for Liver Transplantation and Liver Diseases, Montevideo, Uruguay

Can you tell us a little bit about your respective roles? What is a typical day like for you?

I work as clinical pharmacologist in the National Center for Liver Transplantation and Liver Diseases. It is a privilege for a pharmacist to belong to a highly specialized medical team.

In the mornings I participate in daily rounds where inpatients are discussed, as well as external requests. I make suggestions, review medications and their indications on admission – typically 15 drugs on average for the patients we see, and rationalize administration times to avoid potential drug interactions, duplications, etc. With transplant patients, I assess non-adherence and work to reduce it wherever possible. I am involved in all topics the director assigns me. Every Monday I participate in general surgery rounds and on Wednesday’s liver transplant rounds. I co-coach research meetings held every two weeks.

When possible, I perform PD/PK/PG monitoring of recipients, however, limited resources are the bottle-neck for the widespread provision of the service to our patients.

Is there anything that your laboratory does or that is done at your hospital that you would consider innovative?

Yes, we have some ultimate technology at a national level such as FibroScan® liver elastography and Prometheus® liver dialysis. Our liver transplant program is considered a model in Latin America, due to its conception, funding, organ procurement and allocation strategy, and national scope. Regarding biomarker monitoring, the approach is innovative across the continent and centers in Europe and USA. Our major challenge is the lack of funding for implementation in routine clinical practice. Our preliminary results in four of five population studies are promising, and are in-line with results presented in the first consensus report of biomarkers for immunosuppressant drugs in solid organ transplantation.

What technological innovations have entered into use during your career that have permitted a change, or evolution, in practice?

Our team recognizes the value of PD/PK/PG monitoring and they encourage me to persevere in research and clinical implementation as far as possible. Interdisciplinary interaction is very valuable as problems are discussed from different perspectives. A pharmacologist’s contribution in daily practice is well accepted and recognized.

How did you become interested in your area of expertise?

My PhD director was very encouraging, and things took off after the IATDMCT immunosuppressive drugs committee caught my attention. Congresses have always helped to approach other professionals, and are a great environment to share, exchange, motivate and to help build capacities. Special committees are another way to nucleate expertise and develop guidelines.

What do you consider is the future for TDM and CT? What are you excited about? What are the challenges we face?

TDM and CT are moving with new trends: a leap in technology and informatics will continue to satisfy the demands of research and society through less invasive techniques.

I am very excited with immunotherapy design strategies for hepatocellular carcinoma and the study of the variability in response to immunosuppressant drugs in solid organ transplantation.

Challenges remain and relate to validation of laboratory developed tests, the employment of appropriate reference materials, adoption of global standardized methodologies, level of evidence achieved, multi-centric randomized trials, the promotion of accessibility to equipment and instruments, and regulation.