Adherence to the immunosuppressive regimen in pediatric kidney transplant recipients: A systematic review

Abstract

As most prior reviews on NA focus on adult transplant patients, there is a need for a comprehensive overview on adherence to the immunosuppressive regimen in pediatric kidney transplant patients. This systematic review searched for English-language papers (1990-2008) addressing the prevalence of NA to the immunosuppressive regimen, its consequences, determinants, and interventions in pediatric kidney transplant patients (< age 21 yr). We found 36 papers, showing a prevalence of NA (weighted mean) of 31.8% with adolescents being more at risk compared to younger patients. About 44% of all graft losses and 23% of late acute rejection episodes are associated with NA. Most studies investigated socio-economic, condition-related or treatment-related determinants. Only one educational intervention has been tested but yielded inconclusive results. NA to the immunosuppressive regimen is prevalent with serious clinical consequences in pediatric kidney transplant patients, but the economic consequences have not yet been explored. More studies on determinants of NA are needed. The literature currently lacks fully powered RCTs testing adherence-enhancing interventions. The results of this systematic review identify the gaps in the present evidence-based information regarding NA and can be used as a tool to pursue future adherence research in pediatric populations.

Managing Specialty Medication Services Through a Specialty Pharmacy Program: The Case of Oral Renal Transplant Immunosuppressant Medications

“…Unfortunately, nonadherence to immunosuppressive therapy has been reported in 20%-70% of the transplant population; this wide range is based on variation in adherence measures and study populations. [1][2][3][4][5][6][7] Nonadherence rates with immunosuppressive therapy increase over time since the transplant occurred. 8 Reasons for nonadherence include such patient-related components as understanding the need for immunosuppressive therapy, misunderstanding of the medication regimen, forgetfulness, lack of communication and follow-up with the medical team, and depression.…”

Medication Adherence and Growth in Children with CKD

“…Medication nonadherence is highly prevalent and negatively affects outcomes in patients with chronic childhood medical conditions (11,12), including dialysis patients (13)(14)(15) and kidney transplant recipients (16,17). Treatment of patients with CKD includes multiple medications, high dosing frequency, numerous dose adjustments due to disease progression, and the need for coordination of medication administration timing with meals, all of which create a unique context for medication nonadherence in children (18)(19)(20)(21).…”

Transition from pediatric to adult renal services: a consensus statement by the International Society of Nephrology (ISN) and the International Pediatric Nephrology Association (IPNA)

“…Adult renal services are being exposed to an increasing number of adolescent and young adult patients who have either transitioned from paediatric care or presented directly to adult services. It is recognised that there are substantial risks of nonadherence at the time of transfer from pediatric to adult care and amongst the cohort of patients aged <25 managed in adult care [3,4]. Recovery from acute kidney injury and increased detection of nephrourological problems on antenatal scanning means that there is also an increasing number of children with chronic kidney disease (CKD) stages 1-4 who are being followed by paediatric nephrologists [5,6].…”