Immunosuppressant Therapy Adherence and Graft Failure Among Pediatric Renal Transplant Recipients

Abstract

The study objective was to determine the association between immunosuppressant therapy (IST) adherence and graft failure among pediatric renal transplant recipients (RTRs) using data reported in the United States Renal Data System (USRDS), which contains Medicare prescription claims. RTRs (≤18 years) who received their only transplant during 1995-2000, experienced graft survival more than 6 months posttransplant, had 36 months of USRDS data (or had data until graft failure or death), utilized Medicare IST coverage, and were prescribed cyclosporine/tacrolimus were included. IST adherence was measured by medication possession ratio (MPR). Cox proportional hazards analysis was used to assess the relationship between time to graft failure and continuous MPR. MPR quartiles were used to examine MPR as a categorical variable (Quartile 4 = adherent group, Quartiles 1-3 = nonadherent group). Kaplan-Meier estimates of time to graft failure were compared between adherent and nonadherent groups. 877 RTRs met inclusion criteria. Cox proportional hazards modeling suggested that greater adherence was significantly associated with longer time to graft failure (p = 0.009), after adjusting for relevant clinical factors. Kaplan-Meier analysis found a difference between adherent and nonadherent groups in graft survival by time (v 2 = 5.68, p = 0.017). Interventions promoting adherence should be implemented among pediatric RTRs and parents/guardians to optimize graft survival.

Increasing adherence to immunosuppression: a clinical priority

“…Pinsky et al 1 and Chisholm et al 2 confirmed that decreased adherence to therapy is associated with an increased risk of graft failure 1,2 and death, 1 and with increased health-care costs. 1 specifically, Pinsky et al 1 found that patients in the least adherent and secondleast adherent quartile were at 80% and 63% higher risk of graft failure than patients in the highest quartile, respectively.…”

“…two reports on kidney transplantation, one in adults 1 and one in children (18 years of age or younger), 2 demonstrate the adverse impact of drug non adherence on both clinical 1,2 and economic outcomes. 1 Both the studies by Pinsky et al 1 and Chisholm et al 2 used more sophisticated methodologies than those employed by previous studies, and both included large numbers of patients (n = 15,525 1 and n = 877 2 , respectively), which enhanced their statistical power. Both used sizeable multicenter databases (the medicare prescription refill claims database and the united states renal Data system 1,2 ), which enhanced the generalizability of results, and both assessed adherence to immunosuppression therapy as a continuous parameter in patients on different immunosuppressive regimens.…”

“…Both used sizeable multicenter databases (the medicare prescription refill claims database and the united states renal Data system 1,2 ), which enhanced the generalizability of results, and both assessed adherence to immunosuppression therapy as a continuous parameter in patients on different immunosuppressive regimens. 1,2 Pinsky et al 1 and Chisholm et al 2 measured patient adherence to immunosuppressive therapy by use of the medication possession ratio (mPr), a parameter that varies between 0 and 1 and is defined as the number of days that medication is supplied to the patient over a 1-year interval. so, for instance, a patient who, according to pharmacy records of medicare prescription refill claims, acquired 340 daily doses of his/her prescribed immunosuppressants over a 365-day period, would have an mPr of 340/365, or 0.93. in both studies, transplant recipients were then subdivided into quartiles according to the adherence to therapy, and the clinical outcomes for each quartile were analyzed.…”

Insuffisance rénale chronique de l’enfant

“…Les causes d'échecs précoces sont principalement les thromboses vasculaires et la récidive de la maladie initiale [25]. À long terme la néphropathie chronique d'allogreffe est la première cause de perte du greffon ; outre les facteurs immunologiques, phénomènes d'ischémie-reperfusion, toxicité médicamen-teuse des anticalcineurines, on observe une part croissante de la non observance thérapeutique dans son apparition [29]. Ce problème majeur est observé principalement chez les jeunes adolescents exprimant ainsi leur souffrance face à la maladie chronique.…”

Advancing Transplantation

“…However, we now understand that nonadherence is a significant concern in transplantation and data from the United States Renal Data System have confirmed that it is, indeed, a risk factor for poor graft survival. 32 In order to improve outcomes for our patients, the initial conditions of the transplanted graft need to be assessed, as these have an impact on its long-term survival. Nankivell et al 33 demonstrated that subclinical inflammation posttransplant is a risk factor for progression of chronic interstitial damage.…”