Profiles of Immunosuppressive Nonadherence and Association between Medication Adherence and Tacrolimus Intra-patient Variability Among Stable Kidney Transplant Recipients

Abstract

Background Understanding the modifiable correlates and risk factors for medication non-adherence is essential to develop interventions to improve adherence and thus long-term transplantation outcomes. Methods This single-center cross-sectional study collected 409 validated questionnaires of renal transplant recipients followed in outpatient clinics. The incidence of nonadherence to immunosuppressive therapy (implementation phase) was calculated. Multilevel correlates associated with nonadherence were collected to analyze multilevel correlates of nonadherence in kidney transplant recipients. The relationship between nonadherence and recipient outcomes was also explore. Results The incidence of nonadherence to immunosuppressive drugs in renal transplant recipients was 41.6%. Multiple logistic regression analysis showed that 4 variables were positively associated with immunosuppressive nonadherence, namely without steady partner (OR: 1.722; 95%CI: 1.034–2.866), post-transplant years (OR: 1.240; 95%CI: 1.134–1.356), twice-daily immunosuppressive regimen (OR: 5.522 95%CI: 2.857–10.671), Tac IPV (OR: 1.029 95%CI: 1.007–1.052). There was a significant difference in Tac IPV between the adherent and nonadherent groups. The incidence of rejection was 4.2% (10/239) in the adherent group and 12.4% (21/170) in the nonadherent group(p = 0.002). In addition, nonadherence (OR: 2.967, 95%CI: 1.248–7.058) and Tac IPV (OR: 1.030, 95%CI: 1.001–1.060) were positively correlated with episodes of rejection. Conclusion The higher incidence of immunosuppression nonadherence in renal transplant recipients correlates with lacking a steady domestic partner, longer time since the transplantation, higher frequency of immunosuppressive dosing, and higher Tac IPV. In addition, nonadherence and higher tacrolimus IPV were correlated with episodes of rejection. Tacrolimus IPV can be an additional instrument for identifying recipients at risk of nonadherence.