BackgroundDifferent 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).MethodsPatient-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.ResultsThe 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.ConclusionsParticularly, 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.
IntroductionNon-adherence to immunosuppressive medication is regarded as an important factor for graft rejection and loss after successful renal transplantation. Yet, results on prevalence and relationship with psychosocial parameters are heterogeneous. The main aim of this study was to investigate the association of immunosuppressive medication non-adherence and psychosocial factors.MethodsIn 330 adult renal transplant recipients (≥12 months posttransplantation), health-related quality of life, depression, anxiety, social support, and subjective medication experiences were assessed, and their associations with patient-reported non-adherence was evaluated.Results33.6% of the patients admitted to be partially non-adherent. Non-adherence was associated with younger age, poorer social support, lower mental, but higher physical health-related quality of life. There was no association with depression and anxiety. However, high proportions of clinically relevant depression and anxiety symptoms were apparent in both adherent and non-adherent patients.ConclusionIn the posttransplant follow-up, kidney recipients with lower perceived social support, lower mental and higher physical health-related quality of life, and younger age can be regarded as a risk group for immunosuppressive medication non-adherence. In follow-up contacts with kidney transplant patients, physicians may pay attention to these factors. Furthermore, psychosocial interventions to optimize immunosuppressive medication adherence can be designed on the basis of this information, especially including subjectively perceived physical health-related quality of life and fostering social support seems to be of importance.
Zusammenfassung Prävalenz und modifizierbare Determinanten der Non-Adhärenz bei erwachsenen Nierentransplantatempfängern in einer deutschen StichprobeFragestellung: Das Ziel dieser Querschnittstudie war die Untersuchung der Prävalenz und der modifizierbaren Determinanten der Non-Adhärenz bei erwachsenen Nierentransplantatempfängern in der Nachsorge. SummaryObjectives: The aim of this cross-sectional study was to investigate the prevalence and the modifiable determinants of non-adherence in adult kidney transplant patients in follow-up care. Methods: In 74 patients at least six months post-transplant, self-reported adherence (Basel Assessment of Adherence to Immunosuppressive Medications Scale, BAASIS © ), subjective experience and attitudes after transplantation (Medication Experience Scale for Immunosuppressants, MESI), and depression and anxiety (Hospital Anxiety and Depression Scale, HADS-D) were assessed. Results: Non-adherence to any of the four BAASIS © items was 24.3%. For the sub-dimensions: dose taking, drug holidays, timing deviation more than two hours from prescribed time, and dose reduction, the non-adherence levels were 9.5%, 0%, 17.6% and 2.7%, respectively. Marital status, negative beliefs towards immunosuppressants, and prominent anxiety and depression were associated with non-adherence. Conclusions: Screening for adherence and its indicators is of substantial importance in communication with renal transplant recipients. After detecting non-adherence, supportive interventions can be offered to the patients.
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