title: Race and electronically measured adherence to immunosuppressive medications after deceased donor renal transplantation.
abstract: Nonadherence to immunosuppressive medications may partly explain the worse allograft outcomes among black recipients of renal transplants. In a prospective cohort study of recipients of deceased donor renal transplants, microelectronic cap monitors were placed on bottles of one immunosuppressive medication to (1) measure average daily percentage adherence during the first posttransplantation year and (2) determine the factors associated with adherence. A total of 278 transplant recipients who provided sufficient microelectronic adherence data were grouped into four categories of average daily percentage adherence: 95 to 100% adherence (41.0% of patients), 80 to 95% adherence (32.4%), 50 to 80% adherence (12.9%), and 0 to 50% adherence (13.7%). In the unadjusted ordinal logistic regression model, black race was associated with decreased adherence (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.26 to 0.72; P = 0.001). Cause of renal disease, Powerful Others health locus of control, transplant center, and dosing frequency were also associated with adherence. After adjustment for transplant center and dosing frequency, the association between black race and decreased adherence was substantially attenuated (OR, 0.65; 95% CI, 0.38 to 1.14, P = 0.13). Transplant center (P = 0.003) and increased dosing frequency (OR, 0.43; 95% CI, 0.22 to 0.86, for three or four times per day dosing; OR, 2.35; 95% CI, 1.01 to 5.45, for daily dosing; versus two times per day dosing; P = 0.003) remained independently associated with adherence. Other baseline demographic, socioeconomic, medical, surgical, and psychosocial characteristics were not associated with adherence. The transplant center and dosing frequencies of immunosuppressive medications are associated with adherence and explain a substantial proportion of the race-adherence relationship.
authors.affiliation: Center for Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, 923 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA.
authors.forename: Francis L
authors.initials: FL
authors.lastname: Weng
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Israni
authors.forename: Marshall M
authors.initials: MM
authors.lastname: Joffe
authors.forename: Tracey
authors.initials: T
authors.lastname: Hoy
authors.forename: Christina A
authors.initials: CA
authors.lastname: Gaughan
authors.forename: Melissa
authors.initials: M
authors.lastname: Newman
authors.forename: John D
authors.initials: JD
authors.lastname: Abrams
authors.forename: Malek
authors.initials: M
authors.lastname: Kamoun
authors.forename: Sylvia E
authors.initials: SE
authors.lastname: Rosas
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Mange
authors.forename: Brian L
authors.initials: BL
authors.lastname: Strom
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Brayman
authors.forename: Harold I
authors.initials: HI
authors.lastname: Feldman
mesh_terms: D000328:Adult; D001741:Black or African American; D004334:Drug Administration Schedule; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006268:Health Facilities; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016312:Treatment Refusal
chemical_list: D007166:Immunosuppressive Agents