Population Pharmacokinetics and Dosing Optimization of Vancomycin in Pediatric Liver Transplant Recipients

Vancomycin dosing to achieve adequate exposure in pediatric liver transplant recipients had not been established despite the significant infection risk in this population. This retrospective study analyzed 1,158 vancomycin concentrations across 270 pharmacokinetic profiles from 161 pediatric liver transplant recipients, building a population pharmacokinetic model with Phoenix NLME and using Monte Carlo simulation to evaluate dosing adequacy. Lower serum creatinine and shorter time since transplant were associated with higher vancomycin clearance, and simulations showed only 16% of patients achieved the target AUC/MIC ratio of 400 or higher under standard dosing. The findings suggest that standard vancomycin dosing is often insufficient in pediatric liver transplant recipients, and higher or more frequent dosing may be needed to achieve adequate drug exposure.