The Impact of Health Care Appointment Non-Adherence on Graft Outcomes in Kidney Transplantation

Abstract

Background: Non-adherence to medication is a well-studied and known cause of late allograft loss, but it is difficult to measure and prospectively monitor. The aim of this study was to assess if appointment non-adherence was correlated with medication non-adherence and a predictor of graft outcomes. Methods: This was a longitudinal cohort study that used the National United States Renal Data System and veterans affairs health records data with time-to-event analyses conducted to assess the impact on graft and patient survival. Results: The number of transplants that were included in the analysis was 4,646 (3,656 with complete records); 14.6% of patients had an appointment no show rate of ≥12% (non-adherence). Appointment and medication non-adherence were highly correlated and both were significant independent predictors of outcomes. Those with appointment non-adherence had 1.5 times the risk of acute rejection (22.0 vs. 14.7%, p < 0.0001) and a 65% higher risk of graft loss (adjusted hazards ratio (aHR) 1.65, 95% CI 1.38-1.97, p < 0.0001). There was a significant interaction between appointment and medication non-adherence; those with appointment and medication non-adherence were at very high risk of graft loss (aHR 4.18, 95% CI 3.39-5.15, p < 0.0001), compared to those with only appointment non-adherence (aHR 1.39, 95% CI 0.97-2.01, p = 0.0766) or only medication non-adherence (aHR 2.44, 95% CI 2.11-2.81, p < 0.0001). Conclusion: These results demonstrate that non-adherence to health care appointments is a significant and independent risk factor for graft loss.

Evaluation of adherence and tolerability of prolonged‐release tacrolimus (Advagraf™) in kidney transplant patients in Germany: A multicenter, noninterventional study

“…Dew et al concluded from a meta‐analysis of 147 transplantation studies that nonadherence in renal allograft recipients was highest among solid organ transplant recipients, reaching 36 cases per 100 patients per year . Nonadherence has been associated with graft loss, and results from a recent meta‐analysis indicated that the odds of allograft failure increased sevenfold in nonadherent renal transplant recipients . Furthermore, nonadherence has been recognized as an independent risk factor for the development of de novo donor‐specific antibodies, a major cause of graft loss …”

Adherence in Kidney Transplant Recipients

“…The importance of these particular domains, or others, have not yet been sufficiently tested or demonstrated for ESRD patients who have received a kidney transplant. The data presented by Taber et al [1 ] clearly suggest that our model of requisite behaviors for kidney transplant patients needs to extend beyond medication taking, and include, at least, appointment adherence as well.…”

“…In their article in this issue, Taber et al [1] , examine the role of appointment non-adherence in graft outcomes in kidney transplantation. They find that appointment non-adherence is a significant and independent predictor of negative outcome beyond medication non-adherence.…”

Randomised controlled trial of a video intervention and behaviour contract to improve medication adherence after renal transplantation: the VECTOR study protocol

“…Further, costs of the intervention will be compared with gains in utility based on the SF12. Adherence to appointments, staff time in administering the intervention and days in hospital during the study period will be collected retrospectively at the study end and reported to the SSRL by the study site leads 50. The site leads will remain blind to participant allocation and the SSRL will incorporate the information into the final dataset and deidentify it before providing it to the research team for analysis.…”