Nonadherence to therapy after adult solid organ transplantation: A focus on risks and mitigation strategies

Doyle, Ian C.; Maldonado, Angela Q.; Heldenbrand, Seth; Tichy, Eric M.; Trofe‐Clark, Jennifer

doi:10.2146/ajhp150650

Cited by 13 publications

(11 citation statements)

References 80 publications

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“…Among adult recipients, there is at least some support for the role of variables in all five categories (examples are in Figure 1). 16,[25][26][27][28][29] Among the most consistently found and most potent risk factors is past MNA. 16,25,30,31 A meta-analysis found that three factors-nonwhite ethnicity, poor social supports, and poor perceived health-increased patients' risk for immunosuppressant MNA, but the effect of these factors, although consistent, is relatively small.…”

Section: Quantitative Studiesmentioning

confidence: 99%

Understanding Medication Nonadherence after Kidney Transplant

Nevins

Nickerson

Dew

2017

JASN

131

122

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Alloimmunity remains a barrier to long-term graft survival that necessitates lifelong immunosuppressive therapy after renal transplant. Medication nonadherence has been increasingly recognized as a major impediment to achieving effective immunosuppression. Electronic medication monitoring further reveals that nonadherence manifests early after transplant, although the effect is delayed. The etiology of nonadherence is multifactorial, with the strongest risk factors including past nonadherence and being an adolescent or young adult. Other risk factors with smaller but consistently important effects include minority race/ethnicity, poor social supports, and poor perceived health. In children, risk factors related to parental and child psychologic and behavioral functioning and parental distress and burden are also important. Qualitative systematic reviews highlight the need to tailor interventions to each transplant recipient's unique needs, motivations, and barriers rather than offer a one size fits all approach. To date, relatively few interventions have been studied, and most studies conducted were underpowered to allow definitive conclusions. If the kidney transplant community's goal of "one transplant for life" is to become a reality, then solutions for medication nonadherence must be found and implemented.

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Section: Quantitative Studiesmentioning

confidence: 99%

Understanding Medication Nonadherence after Kidney Transplant

Nevins

Nickerson

Dew

2017

JASN

131

122

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“…7 Most studies assessing medication non-adherence use indirect measures, such as self-report, medication refill assessment (through medication possession ratios [MPRs]), or electronic home-based surveillance systems. 8 Tracking of timely refills through MPRs using pharmacy claims data appears to be a valid indirect measure of medication non-adherence and one of the more promising and logistically feasible mechanisms for population-based surveillance. 9–11 However, it is still difficult to do within the U.S. health care environment, as health care is fragmented and patients may refill medications at multiple pharmacies and across different systems of care.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Health Care Appointment Non-Adherence on Graft Outcomes in Kidney Transplantation

Taber

Fleming

Fominaya³

et al. 2016

Am J Nephrol

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Background: Non-adherence to medication is a well-studied and known cause of late allograft loss, but it is difficult to measure and prospectively monitor. The aim of this study was to assess if appointment non-adherence was correlated with medication non-adherence and a predictor of graft outcomes. Methods: This was a longitudinal cohort study that used the National United States Renal Data System and veterans affairs health records data with time-to-event analyses conducted to assess the impact on graft and patient survival. Results: The number of transplants that were included in the analysis was 4,646 (3,656 with complete records); 14.6% of patients had an appointment no show rate of ≥12% (non-adherence). Appointment and medication non-adherence were highly correlated and both were significant independent predictors of outcomes. Those with appointment non-adherence had 1.5 times the risk of acute rejection (22.0 vs. 14.7%, p < 0.0001) and a 65% higher risk of graft loss (adjusted hazards ratio (aHR) 1.65, 95% CI 1.38-1.97, p < 0.0001). There was a significant interaction between appointment and medication non-adherence; those with appointment and medication non-adherence were at very high risk of graft loss (aHR 4.18, 95% CI 3.39-5.15, p < 0.0001), compared to those with only appointment non-adherence (aHR 1.39, 95% CI 0.97-2.01, p = 0.0766) or only medication non-adherence (aHR 2.44, 95% CI 2.11-2.81, p < 0.0001). Conclusion: These results demonstrate that non-adherence to health care appointments is a significant and independent risk factor for graft loss.

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“…Other variables which may impact AR and/or graft loss include subclinical rejection and immunosuppressant adherence. In both cases this information was not available from the published papers and we did not collect this data in our cohort so the inclusion of these variables in our analysis was not possible, though both of these have been shown to be important in rejection risk and health of the allograft (90, 91).…”

Section: Discussionmentioning

confidence: 99%

Analysis of 75 Candidate SNPs Associated With Acute Rejection in Kidney Transplant Recipients: Validation of rs2910164 in MicroRNA MIR146A

et al. 2019

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Background: Identifying kidney allograft recipients who are predisposed to acute rejection (AR) could allow for optimization of clinical treatment to avoid rejection and prolong graft survival. It has been hypothesized that part of this predisposition is caused by the inheritance of specific genetic variants. There are many publications reporting a statistically significant association between a genetic variant, usually in the form of a single nucleotide polymorphism (SNP), and AR. However, there are additional publications reporting a lack of this association when a different cohort of recipients is analyzed for the same SNP. Methods: In this report we attempted to validate 75 common genetic variants, which have been previously reported to be associated with AR, using a large kidney allograft recipient cohort of 2,390 European-Americans and 482 African Americans. Results: Of those variants tested, only one variant, rs2910164, which alters expression of the microRNA MIR146A, was found to exhibit a significant association within the African American cohort. Suggestive variants were found in the genes CTLA and TLR4. Discussion: Our results show that most variants previously reported to be associated with AR were not validated in our cohort. This shows the importance of validation when reporting associations with complex clinical outcomes such as AR. Additional work will need to be done to understand the role of MIR146A in the risk of AR in kidney allograft recipients.

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Nonadherence to therapy after adult solid organ transplantation: A focus on risks and mitigation strategies

Cited by 13 publications

References 80 publications

Understanding Medication Nonadherence after Kidney Transplant

Understanding Medication Nonadherence after Kidney Transplant

The Impact of Health Care Appointment Non-Adherence on Graft Outcomes in Kidney Transplantation

Analysis of 75 Candidate SNPs Associated With Acute Rejection in Kidney Transplant Recipients: Validation of rs2910164 in MicroRNA MIR146A

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