Prevalence and Modifiable Factors for Holistic Non-Adherence in Renal Transplant Patients: A Cross-Sectional Study

Abstract

Introduction In renal transplant recipients, compliance with medical therapy is vital. Non-adherence is considered a risk factor for worst outcomes in kidney recipients, with attributed outcomes of 64% for graft loss and 80% for late acute rejection. Most literature defines adherence as self-based immunosuppression compliance but does not consider other relevant factors such as consult and procedure compliance. Therefore, this study aims to describe adherence prevalence in kidney transplant recipients and the factors related to non-adherence. Methods This cross-sectional study included 1030 renal transplant patients followed by Colombiana de Trasplantes between January 2019 and July 2021. Sociodemographic and clinical variables were obtained based on clinical records. The mental-health group diagnosed holistic adherence in a semi-structured interview. The diagnosis considered medication intake failure, frequency and number of failures to medical controls or other procedures, suspicious non-adherence behaviors, and serum levels of immunosuppressants. A bivariate followed a descriptive analysis, and a forward logistic regression was performed for non-adherence. Results Patients had a median of 47 years, and 58.1% were male. Non-adherence was presented in 30.7% of patients. The non-adherence patients were younger, with a higher prevalence of males, single, divided transplant care, had a longer time after transplantation, psychopathological diagnosis, and more reinforcement education by only nursing. Older age and multidisciplinary reinforcement education were protective factors. On the other hand, poor social support, psychopathology diagnosis, and longer time after transplant presented as non-adherence risk factors. Conclusion Holistic non-adherence was diagnosed in approximately one-third of renal transplant recipients. Its definition included more than just medication non-compliance and could identify more non-adherent patients. Notably, there is a need to consider the related factors in the health follow-up and encourage future research in modifiable factor interventions aiming to increase adherence and achieve better outcomes for renal transplant patients.

The combinatorial effect of age and biological sex on alloimmunity and transplantation outcome

“…Of note, a recent study comparing the adherence in young female vs. male kidney transplant recipients showed that female recipients presented with an improved adherence to immunosuppression ( 24 ). An additional study supported those observations, identifying male sex as a risk factor for non-adherence ( 25 ). Work by us and others has focused on the effects of biological sex showing augmented acute rejection rates in young female recipients, emphasizing on the relevance of biological sex and age factors affecting transplant outcomes ( 4 , 8 ).…”

Is Non-Adherence Associated with Adverse Outcomes in Kidney Transplant Recipients? The Role of Non-Adherence as a Risk and Predictor Factor for Graft Loss and Death

“…Moreover, as non-adherent patients are a high-risk population, a wide definition permits a broader diagnosis of patients that may need special care to reduce the risk of worst outcomes. 27 Graft loss was presented in 3.7% of our patients. Similar to the observational study published by Prihodova, 12 who evidenced a graft loss prevalence of 4.4% in kidney transplant patients.…”