Medication adherence in the transition of adolescent kidney transplant recipients to the adult care

Abstract

Non-adherence is common in adolescent and young adult kidney transplant recipients, leading to adverse graft outcomes. The aim of this study was to determine if adherence to immunosuppressant medications changes during transition from a pediatric to an adult program within the same transplant center. Adherence was assessed for a period of two years before and two years after the transfer. Sub-therapeutic trough levels of serum tacrolimus and level variability were used as measures of adherence. Twenty-five patients were transitioned between 1996 and 2011 at the median age of 22.3 [IQR 21.6 to 23.0] years. Young adults 21 to 25 years of age (n=26) and non-transitioned adolescents 17 to 21 years of age (currently followed in the program, n=24 and those that lost their grafts prior to the transfer, 22) formed the comparison groups. In the transitioned group, adherence prior to the transfer was not significantly different from the adherence after the transfer (p=0.53). The rate of non-adherence in the group of non-transitioned adolescents who lost their grafts (68%) was significantly higher than in the transitioned group (32%, p=0.01). In the group of young adults, adherence was not significantly different from the transitioned group (p=0.27). Thus, transition was not associated with differences in medication adherence in this single-center study. Large-scale studies are needed to evaluate the national data on medication adherence after transfer.

Patient-reported non-adherence and immunosuppressant trough levels are associated with rejection after renal transplantation

“…Therefore, a standardization with the mean, i.e. the CV, is preferable [15, 19, 21, 24, 25, 28] and has also been found to be more reliable [24]. By using standardization by the target level instead of the unstandardized blood levels we excluded variation due to changing IS target levels for medical reasons [10] in the present study.…”

A Review of Pediatric Chronic Kidney Disease

“…Medication adherence is assumed to be a major factor in graft loss during transitions. However, a recent study by Akchurin et al [47] evaluated the differences of adherence in a transitioned vs. non-transitioned adolescent group and overall found no significant difference. Improved outcomes when transitioned at an older age may be related to survival bias, with those who successfully navigate adolescence being able to transition more successfully.…”

“…Patients with a functioning graft at age 17 have a 42.4% likelihood of losing the graft by age 24 [46] . Various studies have shown that transition to adult care at an age younger than 21 was associated with higher failure rates [47] . Medication adherence is assumed to be a major factor in graft loss during transitions.…”

Transitional care in pediatric urology

“…39 A planned and orderly transition program can minimize the risk for noncompliance and graft loss. 40 Children with chronic kidney disease require lifetime follow-up to prevent the progression of disease and monitor for early signs of renal deterioration. The long-term effects of these varied congenital anomalies range in severity but include urinary tract infection, bladder dysfunction, hypertension, nephrolithiasis, and renal hyperfiltration.…”