Predicting acute rejection in children, adolescents, and young adults with a kidney transplant by assessing barriers to taking medication

Varnell, Charles D.; Rich, Kristin Loiselle; Zhang, Bin; Carle, Adam C.; Pai, Ahna L. H.; Modi, Avani C.; Hooper, David K.

doi:10.1007/s00467-021-04946-8

Cited by 14 publications

(9 citation statements)

References 37 publications

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“…However, if there are concerning trends of missed or late medication doses, then this facilitates conversation, identification of barriers, and implementation of evidence-based strategies to improve adherence. In fact, there is strong support for the efficacy of adherence promotion interventions by nonpsychologists (Wu & Pai, 2014) and our own team has demonstrated success in reducing organ rejection episodes when implementing a systematic approach to address adherence barriers in the clinic setting (Varnell et al, 2021). Clinicians looking for additional guidance on selecting EM technology that meets the needs and resources of their specific pediatric population can consult a recent review by Mason et al (2022).…”

Section: Discussionmentioning

confidence: 99%

Electronic monitoring of adherence in clinical care: Ethical and practical considerations.

Rich¹,

Pai²,

Varnell³

et al. 2022

Clinical Practice in Pediatric Psychology

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Objective: Adherence to prescribed medical regimens is a key behavior for managing disease burden and progression. Despite the importance of understanding a child's adherence, many evidence-based assessment strategies have not been implemented into subspecialty clinical practice. The aim of this article was to highlight the potential ethical and regulatory challenges of using electronic monitoring (EM) of adherence in clinical care and offer practical solutions. Methods: Relevant ethical and legal standards were researched and summarized as applicable to EM of adherence. Results: Issues related to Human Relations, Privacy and Confidentiality, Record Keeping, and Assessment all apply to EM of adherence. Conclusions: Clinicians should be mindful and seek to proactively address issues related to informed consent, autonomy, privacy, and equity before starting an EM program of adherence. Multidisciplinary teams should thoroughly consider the ethical and legal aspects of implementing this form of adherence assessment into clinical practice. Implications for Impact StatementThis topical review is the first to describe the practical implications of utilizing electronic monitoring of adherence in a clinical care setting with a multidisciplinary medical team. This is an important reference for any pediatric psychologist or practitioner who wants to be fully informed about the potential ethical and legal ramifications of using this technology with youth.

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Section: Discussionmentioning

confidence: 99%

Electronic monitoring of adherence in clinical care: Ethical and practical considerations.

Rich¹,

Pai²,

Varnell³

et al. 2022

Clinical Practice in Pediatric Psychology

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“…Push notifications are sent to the patient via SMS text messaging and the patient then accesses DEAP through a link within the message. It first assesses high-impact, system-level barriers (i.e., trouble getting to the pharmacy, pharmacy not having the medication, cannot afford the medication) and the top endorsed adherence barriers according to previous research (i.e., forgetting, difficulty swallowing pills, disliking the taste, embarrassment, side effects; Varnell et al, 2021). After the assessment, the system provides evidence-based solutions and/or healthcare team triage (see Figure 1).…”

Section: Methodsmentioning

confidence: 99%

“…Our team has developed the Medication Adherence Promotion System (MAPS), which systematically identifies adherence barriers at point of care (Rich et al, 2018; Varnell et al, 2017) and provides evidence-based strategies to improve adherence via shared decision making (Hooper et al, 2022). Standardized assessment of patient-identified barriers, like MAPS, can help predict clinical outcomes including organ rejection, hospitalization, and death (Simons et al, 2010; Varnell et al, 2021). Indeed, implementation of the MAPS system resulted in a 45% reduction in kidney rejection (Hooper et al, 2022) and was found to be cost-effective (Varnell et al, 2022).…”

mentioning

confidence: 99%

Development and testing of a digitally enabled adherence platform.

Abelson,

Hooper,

Varnell

et al. 2024

Clinical Practice in Pediatric Psychology

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Objective: To develop a digitally enabled adherence platform (DEAP) using evidence-based adherence promotion strategies through iterative testing with patients, design specialists, and adherence experts. Method: Adolescents and young adults (AYAs) with a kidney transplant from a large, midwestern transplant program were recruited to participate in this study. Through an iterative process, we conducted focus groups, individual interviews, empathy interviews/mapping, and usability testing and evaluation to develop and refine the initial version of DEAP. Results: Three empathy maps were created to assess the unique needs of patients, caregivers, and healthcare providers. Eleven patients were then recruited to participate in usability testing of the platform. Platform engagement was high with nine of the 11 participants viewing their initial messages/surveys, usability was rated as high (M = 81.88, SD = 9.61, range = 67.5–95.0), and user-friendliness was rated as excellent (M = 5.88, SD = 0.74, range = 5.0–7.0). Participants also noted multiple opportunities for improving the look and design of DEAP. Conclusions: Engaging with multiple stakeholders and piloting a small usability study have demonstrated support for the acceptability and usability of DEAP, a mobile health platform to address barriers to taking immunosuppression medication for AYAs who have received kidney transplants. Future work is planned to develop a better patient and clinician user experience, increase personalization, and facilitate patient–clinician engagement using this platform.

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“…A recent study showed that patients with medication noncompliance were more than twice as likely to develop biopsy-proven acute rejection as compared with those who did not identify such barriers [26 ▪ ]. Low or irregular calcineurin inhibitor trough levels may be a sign of nonadherence.…”

Section: Causes For Allograft Dysfunctionmentioning

confidence: 99%

Approach to acute kidney injury following paediatric kidney transplant

Atlas-Lazar

Erez

2023

Current Opinion in Pediatrics

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Purpose of reviewIn a child with evidence of acute kidney injury (AKI) following renal transplantation, it is important to quickly and accurately diagnose the cause to enable timely initiation of therapeutic interventions. The following article will discuss the differential diagnosis of acute graft dysfunction in paediatric kidney transplant recipients. This review will systematically guide the clinician through the common and less common causes and provide updates on current treatments.Recent findingsIn patients with signs of graft dysfunction, rejection is an important cause to consider. Diagnosis of rejection relies on biopsy findings, an invasive and costly technique. Over the past 5 years, there has been a focus on noninvasive methods of diagnosing rejection, including serum and urinary biomarkers.SummaryThis review discusses the differential diagnosis of acute graft dysfunction following transplant, with a focus on acute rejection, urinary tract infections and common viral causes, prerenal and postrenal causes, nephrotoxic medications, specifically calcineurin inhibitor toxicity, thrombotic microangiopathy and recurrence of the underlying disease. Each condition is discussed in detail, with a focus on clinical clues to the cause, incidence in the paediatric population, workup and treatment.

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Predicting acute rejection in children, adolescents, and young adults with a kidney transplant by assessing barriers to taking medication

Cited by 14 publications

References 37 publications

Electronic monitoring of adherence in clinical care: Ethical and practical considerations.

Electronic monitoring of adherence in clinical care: Ethical and practical considerations.

Development and testing of a digitally enabled adherence platform.

Approach to acute kidney injury following paediatric kidney transplant

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