Detecting, preventing and treating non-adherence to immunosuppression after kidney transplantation

Clinical Kidney Journal, Journal Year: 2022, Volume and Issue: 15(7), P. 1253 - 1274

Published: Jan. 12, 2022

ABSTRACT Medication non-adherence (MNA) is a major issue in kidney transplantation and it associated with increased risk of rejection, allograft loss, patients’ death higher healthcare costs. Despite its crucial importance, still unclear what are the best strategies to diagnose, prevent treat MNA. MNA can be intentional (deliberate refusal take medication as prescribed) or unintentional (non-deliberate missing prescribed medication). Its diagnosis may rely on direct methods, aiming at measuring drug ingestions, indirect methods that analyse habits patients adhere correct dose (taking adherence) interval (time adherence). Identifying individual factors for provide basis personalized approach treatment Randomized control trials performed so far have tested combination strategies, such enhancing adherence through commitment personnel involved distribution, use electronic reminders, therapy simplification various multidisciplinary approaches maximize correction factors. Although most these reduced short-term, long-term effects and, more importantly, clinical outcomes remain unclear. In this review, we critical appraisal traditional newer detecting, preventing treating immunosuppression after from perspective practising physician.

Language: Английский

---

Intrapatient tacrolimus variability is associated with medical nonadherence among pediatric kidney transplant recipients

Frontiers in Transplantation, Journal Year: 2025, Volume and Issue: 4

Published: March 17, 2025

Long-term survival of kidney allografts is limited by multiple factors, including nonadherence. High intrapatient variability in tacrolimus levels (≥30%) associated with de novo donor-specific antibody (dnDSA) formation, increased risk rejection and graft loss. We prospectively analyzed the association between nonadherence pediatric transplant recipients. derived a composite adherence score from 0 to 3 points based on (1) Basel Assessment Adherence Immunosuppressive Medical Scale©; (2) healthcare team score; (3) intentionally missed laboratory or clinic visits. A 1 more was considered nonadherent. Tacrolimus 12 h trough levels, patient characteristics clinical outcomes were collected. IPV calculated as coefficient variation. The nonadherent group had significantly higher median (31%) compared adherent cohort (20%) (p < 0.001.) Tac demonstrated strong predictive performance for (AUC 0.772), particularly high sensitivity 90% at thresholds up 20%, offering practical actionable framework assessing adherence-related risks practice. may be useful biomarker identify high-risk patients, allowing early interventions prevent adverse outcomes.

Language: Английский

---

Follow-Up Factors Contribute to Immunosuppressant Adherence in Kidney Transplant Recipients

Patient Preference and Adherence, Journal Year: 2022, Volume and Issue: Volume 16, P. 2811 - 2819

Published: Oct. 1, 2022

Follow-up and immunosuppressive medication (ISM) adherence are both important for kidney transplant recipients postoperatively whether follow-up factors affect the ISM remains unclear. The aim of this study was to examine relationship between adherence, associated with adherence.An internet-based cross-sectional survey conducted in a single center China. participants completed questionnaire Basel Assessment Adherence Immunosuppressive Medication Scale (BAASIS©) from January 12 26, 2021.Finally, 288 (66.7%) responded survey. percentage full immunosuppressant 51.7% (149/288), 33.3% reporting problem timing dimension. We found that fixed doctor significantly positive good (OR=2.124, 95% CI=1.111-4.062, P=0.023) after analyzing data. Time since transplantation number non-immunosuppressants were adherence. No significant difference regarding effect on adherence.Our demonstrated an insufficient prevalence Chinese renal revealed may be way improve patients' This anonymous provides valuable insight into actual rate, non-adherence, situations medication-taking.

Language: Английский

---

Intrapatient Tacrolimus Variability is Associated with Medical Nonadherence among Pediatric Kidney Transplant Recipients

Research Square (Research Square), Journal Year: 2024, Volume and Issue: unknown

Published: Nov. 4, 2024

Background: Long-term survival of kidney allografts is limited by multiple factors, including nonadherence. High intrapatient variability (IPV) in tacrolimus levels (≥30%) associated with de novo donor-specific antibody (dnDSA) formation, increased risk rejection and graft loss. Methods: We prospectively analyzed the association between IPV nonadherence pediatric transplant recipients. derived a composite adherence score from 0-3 points based on (1) Basel Assessment Adherence to Immunosuppressive Medical Scale^Ó; (2) healthcare team score; (3) intentionally missed laboratory or clinic visits. A 1 more was considered nonadherent. Tacrolimus 12-hour trough levels, patient characteristics clinical outcomes were collected. calculated as coefficient variation. Results: The nonadherent group had significantly higher median (31%) compared adherent cohort (20%) (p < 0.001), positive correlation (r = 0.44, p 0.001). Antibody T-cell mediated rejection, along dnDSA formation prevalent patients those high IPV. Conclusions: may be useful biomarker identify high-risk patients, allowing for early interventions prevent adverse outcomes.

Language: Английский

---

The improving Medication Adherence in Adolescents and young adults following Liver Transplantation (iMALT) multisite trial: Design and trial implementation considerations

Clinical Trials, Journal Year: 2023, Volume and Issue: 20(5), P. 528 - 535

Published: June 2, 2023

Medication non-adherence is a leading cause of transplant rejection, organ loss, and death; yet no rigorous controlled study to date has shown compelling clinical benefits from an adherence-improving intervention. Non-adherent patients are less likely participate in trials, therefore, most studies enroll majority adherent who do not stand benefit the intervention, as they have condition (non-adherence) under investigation. The improving Adherence adolescent Liver Transplant recipients trial specifically targets non-adherent investigate whether remote intervention improve adherence results reduced incidence biopsy-confirmed rejection.Improving randomized single-blind multisite, multinational National Institutes Health-funded involving 13 pediatric centers United States Canada. An innovative, objective biomarker-the Level Variability Index, which standard deviation series medication blood levels for each patient, used identify at risk rejection. index computed using electronic health record information all potentially eligible based on repeated reviews entire clinic's roster. Identified patients, after consent, versus control (treatment usual) arms. delivered 2 years by trained interventionists reside various locations States. primary outcome acute cellular confirmed vote three pathologists masked allocation information.Improving includes several innovative design elements. use validated, survey large cohort allows teams avoid bias inherent both convenience sampling referral-based recruitment only whose indicates substantially increased paradigm helps engage definition hard engage. objective, medical (rather than behavioral) measure reduces likelihood biases related ensures broad acceptance field. Finally, monitoring potential adverse events exposure due acknowledges that successful (increasing adherence) could detrimental side effects via toxicity medication. Such almost never attempted trials evaluating interventions.

Language: Английский

---

Improving adherence: It’s complicated

American Journal of Transplantation, Journal Year: 2021, Volume and Issue: 21(5), P. 1679 - 1680

Published: May 1, 2021

This month's installment of “The AJT Report” discusses effective strategies for addressing patients’ nonadherence to immunosuppression, and reports on the latest guidance concerning COVID-19 vaccination pre- posttransplant patients.

Language: Английский

---