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

• Published in: BMC nephrology 2017-03, Vol.18 (1), p.107-107, Article 107
• Main Authors: Scheel, Jennifer, Reber, Sandra, Stoessel, Lisa, Waldmann, Elisabeth, Jank, Sabine, Eckardt, Kai-Uwe, Grundmann, Franziska, Vitinius, Frank, de Zwaan, Martina, Bertram, Anna, Erim, Yesim
• Format: Article
• Language: English
• Subjects: Allografts; Biopsy; Blood levels; Calcineurin; Calcineurin inhibitors; Children; Cognitive ability; Cyclosporin A; Cyclosporins; Dose-Response Relationship, Drug; Drug dosages; Edetic acid; Ethics; Female; Germany - epidemiology; Graft rejection; Graft Rejection - epidemiology; Graft Rejection - prevention & control; Hospitals; Humans; Immune clearance; Immunosuppressant trough level variability; Immunosuppressive agents; Immunosuppressive Agents - administration & dosage; Inventories; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - surgery; Kidney transplantation; Kidney Transplantation - statistics & numerical data; Kidney transplants; Liquid chromatography; Liver; Longitudinal Studies; Male; Mass spectrometry; Medication Adherence - statistics & numerical data; Nephrology; Nephropathy; Patient compliance; Patient Reported Outcome Measures; Patient-reported non-adherence; Patients; Pediatrics; Pharmacokinetics; Prevalence; Rejection; Renal function; Retrospective Studies; Risk Factors; Scientific imaging; Social interactions; Sub-therapeutic immunosuppressant trough levels; Tacrolimus; Transplantation; Transplants & implants; Treatment Outcome
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-017-0517-6

Different measures of non-adherence to immunosuppressant (IS) medication have been found to be associated with rejection episodes after successful transplantation. The aim of the current study was to investigate whether graft rejection after renal transplantation is associated with patient-reported IS medication non-adherence and IS trough level variables (IS trough level variability and percentage of sub-therapeutic IS trough levels). Patient-reported non-adherence, IS trough level variability, percentage of sub-therapeutic IS trough levels, and acute biopsy-proven late allograft rejections were assessed in 267 adult renal transplant recipients who were ≥12 months post-transplantation. The rate of rejection was 13.5%. IS trough level variability, percentage of sub-therapeutic IS trough levels as well as patient-reported non-adherence were all significantly and positively associated with rejection, but not with each other. Logistic regression analyses revealed that only the percentage of sub-therapeutic IS trough levels and age at transplantation remained significantly associated with rejection. Particularly, the percentage of sub-therapeutic IS trough levels is associated with acute rejections after kidney transplantation whereas IS trough level variability and patient-reported non-adherence seem to be of subordinate importance. Patient-reported non-adherence and IS trough level variables were not correlated; thus, non-adherence should always be measured in a multi-methodological approach. Further research concerning the best combination of non-adherence measures is needed.