Changes in Beliefs About Post-Transplant Immunosuppressants Over Time and Its Relation to Medication Adherence and Kidney Graft Dysfunction: A Follow-Up Study

Abstract

Purpose The main aim was to evaluate the changes in beliefs about immunosuppressants over a 3-year period in patients after kidney transplantation. The second aim was to investigate the relationship between beliefs, medication adherence, and selected clinical outcomes such as graft functioning. Patients and Methods This observational follow-up study was conducted in the outpatient post-transplant clinic at the University Hospital Hradec Kralove in the Czech Republic. Adult patients, at least 4 weeks after kidney transplantation, were invited for the structured interview, which was followed by a self-administered questionnaire survey during their regularly scheduled visits at the clinic. Appropriate paired tests were used to compare two measurements of beliefs about immunosuppressants by BMQ-CZ© in 2016 (baseline) and in 2019 (follow-up). Self-reported adherence was measured by two validated tools (MARS-CZ© and BAASIS©) capturing implementation and discontinuation phases. A generalized linear model was used to investigate the relation between beliefs and the consecutive estimated glomerular filtration rate. Results The study involved 134 patients. Over time, their perceived treatment necessity beliefs of immunosuppressants decreased, while their treatment-related concerns increased. Overall self-reported non-adherence (ie, taking, dosing and discontinuation of immunosuppressants) was reported by 12% of the patients in both observation periods. In the follow-up period, timing non-adherence was reported by 52 (38.8%) patients. Higher baseline treatment concerns were associated with poor adherence whereas higher baseline treatment necessity beliefs corresponded with better kidney functioning, even after adjusting for age. Conclusion Higher treatment necessity beliefs corresponded with better kidney functioning, whereas higher treatment concerns were related to non-adherence to immunosuppressants at the beginning of the observed period. Still, most patients accepted their medicines that do not come without risk. Nevertheless, decreasing treatment necessity beliefs on one hand, and increasing treatment concerns on the other, should be considered in clinical practice.

Comparison of different methods to assess tacrolimus concentration intra-patient variability as potential marker of medication non-adherence

“…Adherence to immunosuppressants (implementation phase) was assessed by the written version of the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS © ) ( Dobbels et al, 2010 ), translated from English to the Czech language ( Kostalova et al, 2021 ). The BAASIS consists of five self-report items: one on initiation; three on implementation and one on persistence to the prescribed immunosuppression regimen.…”

Can we identify “at‐risk” children and adolescents for poor transplant outcomes in the psychosocial evaluation before solid organ transplantation? The reliability and validity study of Pediatric Transplant Rating Instrument (P‐TRI) in Turkish pediatric renal transplant patients

“…The patients included in the study were 39.7% female (n = 60) and 60.3% male (n = 91). The mean age at transplantation was 11.51 ± 4.97 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). The mean serum creatinine and GFR levels were 2.14 ± 2.66 (0.38-16.09) and 67.22 ± 30.44 (3-128), respectively.…”

“…6 In another study with adult kidney transplant recipients, it was suggested that good treatment compliance may be associated with better kidney function. 7 Also, in pediatric renal transplant recipients, it was reported that medication non-adherence and estimated GFR values were related. 8 GFR and creatinine are one of the two basic parameters to be used to evaluate organ functions after kidney transplantation.…”

“…In a study conducted with adults, it was reported that the risk of late acute rejection increased 3.2 times in patients with treatment non‐adherence, and serum creatinine levels increased in patients with treatment non‐adherence 6 . In another study with adult kidney transplant recipients, it was suggested that good treatment compliance may be associated with better kidney function 7 . Also, in pediatric renal transplant recipients, it was reported that medication non‐adherence and estimated GFR values were related 8 .…”

Development and Internal Validation of a Questionnaire Assessing Predisposition to Nonadherence to Immunosuppressive Medication in Kidney Pretransplant Patients

“…14 After kidney transplant, lifelong immunosuppressive therapy to prevent organ rejection is mandatory. 15,16 It is composed of the daily administration of 2-3 drugs, [17][18][19][20] in addition to treatment for other comorbidities, which implies an average of 10 different medications prescribed per day. [21][22][23] Consequently, the post-kidney transplant patient is susceptible to adverse drug reactions, in addition to a greater risk of infections, diabetes, increased blood pressure, and weight gain.…”