Charles D Varnell1,2,3, Kristin L Rich4,5, Bin Zhang4,6, Adam C Carle7,8, Ahna L H Pai4,5, Avani C Modi4,5, David K Hooper9,7,4. 1. Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7022, Cincinnati, OH, 45229, USA. Charles.Varnell@cchmc.org. 2. James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Charles.Varnell@cchmc.org. 3. Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA. Charles.Varnell@cchmc.org. 4. Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA. 5. Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 6. Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 7. James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 8. Department of Psychology, College of Arts and Sciences, University of Cincinnati, Cincinnati, OH, USA. 9. Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7022, Cincinnati, OH, 45229, USA.
Abstract
BACKGROUND: Nonadherence to immunosuppression is common among pediatric, adolescent, and young adult kidney transplant recipients and a leading cause of graft loss. Assessing barriers to medication adherence in clinical practice may identify patients at risk for rejection and provide therapeutic targets. METHODS: Kidney transplant patients and/or their caregivers were assessed for 14 barriers to medication adherence using the barriers assessment tool. We compared rejection rates between patients with at least one reported adherence barrier to those without reported adherence barriers using a Kaplan-Meier estimator and Cox proportional hazard models to adjust for other mediators of acute rejection at 2 years following barriers assessment. RESULTS: Ninety-eight patients were assessed for barriers to adherence. Over the 2-year observation period, 22 patients developed biopsy-proven acute rejection (BPAR). Kaplan-Meier estimates show that patients with an identified barrier to adherence were more likely to have BPAR (p = 0.02) than patients without an identified barrier in the 24 months following barriers assessment. The median time to rejection for patients who experienced acute rejection was 175.5 days (IQR 63-276 days) from the time of barriers assessment. An identified barrier to adherence remained the only statistically significant predictor of BPAR with Cox modeling (HR 2.6, p = 0.04), after accounting for age, sex, and race. CONCLUSIONS: Pediatric and adolescent kidney transplant recipients with identified adherence barriers are at increased risk for acute rejection. Barriers to adherence provide a potentially modifiable therapeutic target that can be assessed in clinic to guide targeted interventions.
BACKGROUND: Nonadherence to immunosuppression is common among pediatric, adolescent, and young adult kidney transplant recipients and a leading cause of graft loss. Assessing barriers to medication adherence in clinical practice may identify patients at risk for rejection and provide therapeutic targets. METHODS: Kidney transplant patients and/or their caregivers were assessed for 14 barriers to medication adherence using the barriers assessment tool. We compared rejection rates between patients with at least one reported adherence barrier to those without reported adherence barriers using a Kaplan-Meier estimator and Cox proportional hazard models to adjust for other mediators of acute rejection at 2 years following barriers assessment. RESULTS: Ninety-eight patients were assessed for barriers to adherence. Over the 2-year observation period, 22 patients developed biopsy-proven acute rejection (BPAR). Kaplan-Meier estimates show that patients with an identified barrier to adherence were more likely to have BPAR (p = 0.02) than patients without an identified barrier in the 24 months following barriers assessment. The median time to rejection for patients who experienced acute rejection was 175.5 days (IQR 63-276 days) from the time of barriers assessment. An identified barrier to adherence remained the only statistically significant predictor of BPAR with Cox modeling (HR 2.6, p = 0.04), after accounting for age, sex, and race. CONCLUSIONS: Pediatric and adolescent kidney transplant recipients with identified adherence barriers are at increased risk for acute rejection. Barriers to adherence provide a potentially modifiable therapeutic target that can be assessed in clinic to guide targeted interventions.
Authors: K Solez; R B Colvin; L C Racusen; M Haas; B Sis; M Mengel; P F Halloran; W Baldwin; G Banfi; A B Collins; F Cosio; D S R David; C Drachenberg; G Einecke; A B Fogo; I W Gibson; D Glotz; S S Iskandar; E Kraus; E Lerut; R B Mannon; M Mihatsch; B J Nankivell; V Nickeleit; J C Papadimitriou; P Randhawa; H Regele; K Renaudin; I Roberts; D Seron; R N Smith; M Valente Journal: Am J Transplant Date: 2008-02-19 Impact factor: 8.086
Authors: Stacey M Pollock-Barziv; Yaron Finkelstein; Cedric Manlhiot; Anne I Dipchand; Diane Hebert; Vicky L Ng; Melinda Solomon; Brian W McCrindle; David Grant Journal: Pediatr Transplant Date: 2010-10-05
Authors: Charles D Varnell; Kristin L Rich; Melissa Nichols; Devesh Dahale; Jens W Goebel; Ahna L H Pai; David K Hooper; Avani C Modi Journal: Pediatr Transplant Date: 2017-08-01
Authors: Charles D Varnell; Kristin L Rich; Avani C Modi; David K Hooper; Mark H Eckman Journal: Am J Kidney Dis Date: 2022-02-25 Impact factor: 11.072