Kidney-transplanted Adolescents—Nonadherence and Graft Outcomes During the Transition Phase: A Nationwide Analysis, 2000–2020

Abstract

Background. The transition from pediatric to young adult care is a vulnerable period for the renal transplant patient. We aimed to identify medication nonadherence (noninitiation, nonimplementation, and nonpersistence) and graft loss rates among adolescents and young adults and elucidate the influence of the transition phase on transplant outcomes. Methods. A retrospective nationwide cohort analysis of all renal transplantations in Norway from 2000 to 2020 was performed. Data were retrieved from the Norwegian Renal Registry, and adherence data from hospital charts. Patients transplanted aged <50 y, with functioning graft at 6 mo, were included. Recipients transplanted aged <26 y were compared with recipients transplanted aged 26–50 y. Graft loss, acute rejection, and development of de novo donor-specific antibodies were assessed in relation to the transition phase, defined as 14–26 y. Results. Data from 1830 kidney recipients were included: 371 (20%) transplanted <26 y (64% male, 68% living donor) versus 1459 transplanted 26–50 y (63% male, 44% living donor). There were 298 graft losses, 78 (21%) in the <26-y group versus 220 (15%) in the 26- to 50-y group. During the transition phase, 36 grafts were lost, 29 (81%) after transfer to the adult service. Medication nonadherence was the reason for 58% (21 of 36) of the losses during the transition phase, versus 12% (27 of 220) in the 26- to 50-y group ( P < 0.001). The 5-y graft survival rate was 89% (95% confidence interval, 85%-92%) and 94% (92%-95%), respectively ( P = 0.01). Conclusions. Nonadherence was verified as the main cause of kidney graft loss in the transition phase.

Optimizing medication adherence with home‐monitoring – A feasibility study using capillary microsampling and mHealth in solid organ‐transplanted adolescents

“…When the SOT children reach the vulnerable period between childhood and adulthood, they need to take responsibility and organize their own medical treatment, including medication and follow‐up appointments without the same close involvement of the caregivers. The inevitable transfer to adult health care service may for many be a too sudden shift in responsibility, contributing to medication nonadherence and consequently, the highest graft loss rates among the adolescents and young adults 13 . We believe an important issue in future research should be to detect, and direct, interventions including home monitoring/mHealth toward the patients who need it the most i.e., recipients that either already are nonadherent, subclinical nonadherent or those at risk for becoming nonadherent.…”

“…The inevitable transfer to adult health care service may for many be a too sudden shift in responsibility, contributing to medication nonadherence and consequently, the highest graft loss rates among the adolescents and young adults. 13 We believe an important issue in future research should be to detect, and direct, interventions including home monitoring/mHealth toward the patients who need it the most i.e., recipients that either already are nonadherent, subclinical nonadherent or those at risk for becoming nonadherent. Detecting these patients is a challenge.…”

“…Following a transplantation, adherence to life‐long immunosuppressive treatment is mandatory to avoid acute rejections, development of de novo donor‐specific antibodies ( dn DSA) that may induce graft dysfunction and in worst case, that leads to graft loss 7–11 . In the literature, the prevalence of medication nonadherence among pediatric and adult SOT patients ranges from 2% to 67% 7,11–13 . The vast prevalence indicates a wide diversity in methods and definitions used in nonadherence assessment.…”

“…The vast prevalence indicates a wide diversity in methods and definitions used in nonadherence assessment. In a recently published large national registry study, we identified medication nonadherence to be the reason for 58% of the graft losses among kidney transplanted adolescents and young adults aged 14–26 years 13 . Unfortunately, nonadherence to the medical regimen among adolescents and young adults is too common, and there is an extensive potential for improvement through individualized treatment and self‐management.…”

“…[7][8][9][10][11] In the literature, the prevalence of medication nonadherence among pediatric and adult SOT patients ranges from 2% to 67%. 7,[11][12][13] The vast prevalence indicates a wide diversity in methods and definitions used in nonadherence assessment. In a recently published large national registry study, we identified medication nonadherence to be the reason for 58% of the graft losses among kidney transplanted adolescents and young adults aged 14-26 years.…”