Automated Reminders and Physician Notification to Promote Immunosuppression Adherence Among Kidney Transplant Recipients: A Randomized Trial

Reese, Peter P.; Bloom, Roy D.; Trofe‐Clark, Jennifer; Mussell, Adam; Leidy, Daniel; Levsky, Simona; Zhu, Jingsan; Yang, Lin; Wen-li, Wang; Troxel, Andrea B.; Feldman, Harold I.; Volpp, Kevin G.

doi:10.1053/j.ajkd.2016.10.017

Cited by 113 publications

(134 citation statements)

References 49 publications

Supporting

Mentioning

129

Contrasting

Unclassified

Order By: Relevance

“…Studies were conducted in liver (n = 8), kidney (n = 25), heart or heart/lung (n = 2), and lung transplant recipients (n = 4), as well as mixed groups (n = 2). Of the RCTs, 11 did not report on transplant outcomes, and 10 examined them and found no effect of the intervention . Table is a detailed review of the 10 RCTs that looked at transplant outcomes (and found no intervention effect); this table also presents other outcomes that were examined in those studies.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of immunosuppressant adherence interventions in transplant recipients: Decoding the streetlight effect

Duncan

Annunziato

Dunphy

et al. 2017

Pediatric Transplantation

View full text Add to dashboard Cite

Non-adherence to immunosuppressant medications is an important risk factor for graft dysfunction. To evaluate the effectiveness of adherence-enhancing interventions, we reviewed adherence intervention studies in solid organ transplant recipients (all ages). Using the following databases: PsycINFO, PubMed, Scopus, and ScienceDirect, we identified 41 eligible studies. Only three non-randomized trials showed a possible positive effect on objective indicators of transplant outcomes (such as rejection, liver enzyme levels, kidney function). None of the 21 RCTs showed an improvement in transplant outcomes. Three studies showed a higher rate of adverse events in the intervention group as compared with controls, although this may be related to ascertainment bias. Improvement in adherence as measured indirectly (eg, with electronic monitoring devices) was not aligned with effects on transplant outcomes. We conclude that adherence interventions, to date, have largely been ineffective in improving transplant outcomes. To improve this track record, intervention efforts may wish to concentrate on non-adherent patients (rather than use convenience sampling, which excludes many of the patients who need the intervention), use direct measures of adherence to guide the interventions, and employ strategies that are intensive and yet engaging enough to ensure that non-adherent patients are able to participate.

show abstract

Section: Resultsmentioning

confidence: 99%

A systematic review of immunosuppressant adherence interventions in transplant recipients: Decoding the streetlight effect

Duncan

Annunziato

Dunphy

et al. 2017

Pediatric Transplantation

View full text Add to dashboard Cite

show abstract

“…We and others have demonstrated that the use of mobile health technology may significant improve medication adherence and outcomes in transplantation. 49–51 There are ongoing prospective RCTs to further assess this intervention as a promising mechanism to improve graft survival and potentially reduce racial disparities. Finally, the introduction of once daily extended release formulations of tacrolimus has provided intriguing data demonstrating reduced tacrolimus trough variability, particularly within AA recipients.…”

Section: Discussionmentioning

confidence: 99%

Tacrolimus Trough Concentration Variability and Disparities in African American Kidney Transplantation

Taber

Fleming

et al. 2017

Transplantation

View full text Add to dashboard Cite

Background Low tacrolimus concentrations have been associated with higher risk of acute rejection, particularly within African-American (AA) kidney transplant recipients; little is known about intrapatient tacrolimus variabilities impact on racial disparities. Methods Ten year, single-center, longitudinal cohort study of kidney recipients. Intrapatient tacrolimus variability was assessed using the coefficient of variation (CV) measured between 1 month posttransplant and the clinical event, with a comparable period assessed in those without events. Pediatrics, nontacrolimus/mycophenolate regimens and nonrenal transplants were excluded. Multivariable Cox regression models were used to analyze data. Results 1411 recipients were included (54.4% AA) with 39 521 concentrations utilized to assess intrapatient tacrolimus CV. Overall, intrapatient tacrolimus CV was higher in AAs vs non-AAs (39.9±19.8 % vs. 34.8±15.8% p<0.001). Tacrolimus variability was a significant risk factor for deleterious clinical outcomes. A 10% increase in tacrolimus CV augmented the risk of acute rejection by 20% (aHR 1.20, 1.13–1.28; p<0.001) and the risk of graft loss by 30% (aHR 1.30, 1.23–1.37; p<0.001), with significant effect modification by race for acute rejection, but not graft loss. High tacrolimus variability (CV >40%) was a significant explanatory variable for disparities in AAs; the crude relative risk of acute rejection in AAs was reduced by 46% when including tacrolimus variability in modeling and reduced by 40% for graft loss. Conclusions These data demonstrate that intrapatient tacrolimus variability is strongly associated with acute rejection in AAs and graft loss in all patients. Tacrolimus variability is a significant explanatory variable for disparities in AA recipients.

show abstract

“…High CV TAC may reflect a number of factors, including adherence to prescribed medical regimen, barriers to laboratory services (timing and ability to get to laboratory), and variations in medical provider clinical patterns pre‐ and post‐transfer. Prior studies utilizing electronic monitoring of TAC intake in kidney transplant recipients found no association between TAC trough level variability and adherence to their medical regimen . As previously discussed, there may be an influence of number of TAC levels, as well as the effect of a medical provider changing TAC trough targets pre‐ and post‐transfer of care which contributes to variability of TAC levels.…”

Section: Discussionmentioning

confidence: 93%

The effect of transfer to adult transplant care on kidney function and immunosuppressant drug level variability in pediatric kidney transplant recipients

Fernández

Amaral

Shaw

et al. 2019

Pediatric Transplantation

Self Cite

View full text Add to dashboard Cite

Adolescent age at time of transplant has been recognized as a risk factor for renal allograft loss. Increased risk for graft failure may persist from adolescence to young adulthood. Transfer of care is hypothesized as a risk factor for non‐adherence and graft loss. We explored whether kidney allograft function declined at an accelerated rate after transfer of care to adult transplant centers and whether coefficient of variation of tacrolimus (CV TAC) trough levels predicted allograft loss. Single‐center, retrospective chart review was performed for pediatric kidney transplant recipients who received transplants between 1999 and 2011. Change in eGFR pre‐ and post‐transfer was performed via a linear mixed‐effects model. CV TAC was calculated in transplant recipients with TAC data pre‐ and post‐transfer. t test was performed to determine the difference between means of CV TAC in subjects with and without allograft loss following transfer of care. Of the 138 subjects who transferred to adult care, 47 subjects with data pre‐ and post‐transfer demonstrated a decrease in the rate of eGFR decline post‐transfer from 8.0 mL/min/1.73 m2 per year to 2.1 mL/min/1.73 m2 per year, an ~80% decrease in eGFR decline post‐transfer (P = 0.01). Twenty‐four subjects had CV TAC data pre‐ and post‐transfer of care. Pretransfer CV TAC for subjects with allograft loss post‐transfer was significantly higher than in subjects without allograft loss (49% vs 26%, P < 0.05). Transfer of care was not independently associated with acceleration in eGFR decline. CV TAC may aid in identifying patients at risk for allograft loss post‐transfer.

show abstract

Automated Reminders and Physician Notification to Promote Immunosuppression Adherence Among Kidney Transplant Recipients: A Randomized Trial

Abstract: Provider notification and customized reminders appear promising in helping patients achieve better medication adherence, but these strategies require evaluation in trials powered to detect differences in clinical outcomes.

Cited by 113 publications

References 49 publications

A systematic review of immunosuppressant adherence interventions in transplant recipients: Decoding the streetlight effect

A systematic review of immunosuppressant adherence interventions in transplant recipients: Decoding the streetlight effect

Tacrolimus Trough Concentration Variability and Disparities in African American Kidney Transplantation

The effect of transfer to adult transplant care on kidney function and immunosuppressant drug level variability in pediatric kidney transplant recipients

Contact Info

Product

Resources

About