A pilot pathway for penicillin allergy delabelling in liver transplant recipients

• Penicillin allergy labels limit first line antibiotics in liver transplant patients. • A ward-based pathway restored first-line antibiotics during transplant care. • 14 liver patients were safely delabelled, including early post liver transplant. • Delabelling expanded ß-lactam options with no hypersensitivity reactions. • This is among the first UK inpatient delabelling pathways in transplant hepatology. Antibiotic allergy labels (AAL), particularly to penicillin, are common among liver transplant (LT) recipients and can compromise antimicrobial stewardship and increase the risk of multidrug-resistant infection. We retrospectively reviewed adult LT recipients over 12 months to determine the prevalence of AAL and antibiotic use, and piloted a pharmacist- and microbiologist-led delabelling pathway for low-risk patients. Among 83 LT recipients, AAL prevalence was 20%, with 12% reporting penicillin allergy and no prior delabelling attempts identified. Patients were screened weekly on a 31-bed hepatopancreaticobiliary ward, and 14 patients (age 35–83 years) were safely delabelled, including nine with liver disease (five of whom were transplant patients). All drug provocation tests were negative and no adverse events occurred. This pilot demonstrates the feasibility and safety of a microbiologist-led penicillin delabelling pathway within a ward based liver transplant programme. To our knowledge, this is the first UK example of such a protocol integrated within a transplant hepatology service, complementing emerging international data supporting antibiotic allergy delabelling in transplant and immunocompromised populations.