title: A retrospective analysis of immunosuppression compliance, dose reduction and discontinuation in kidney transplant recipients.
abstract: We describe factors associated with poor compliance and dose reductions and examine the relative impact of compliance, dose reduction and discontinuation on graft outcome. Medicare claims for MMF in 7062 deceased donor renal recipients with at least 1 year of graft function were used to calculate compliance and dose reductions. Compliance was modeled using medication possession ratio to define quartiles for poor, low, medium and high compliance. The relative impact of compliance, dose reduction and discontinuation on graft outcome was assessed with Cox proportional hazards. Pediatric (Age 0-18, Odds ratio = 1.71, 95% CI 1.11-2.63, p = 0.014) and adolescent recipients (19-24, 1.57, 1.23-2.00, p < 0.001) were more likely poorly compliant compared to adults age 25-44. Poor compliance was also associated with physical limitations, hypertension, delayed graft function, rejection, infection and GI conditions. Poor (1.43, 1.11-1.84, p = 0.005) and low (1.46, 1.13-1.88, p = 0.004) compliance was associated with an increased hazard of graft loss as was >50% dose reduction (1.69, 1.15-2.50, p = 0.008) and discontinuation (8.34, 6.85-10.2, p < 0.001). Medication possession ratios lower than the 3-year mean were associated with an increased risk of graft loss. These results may indicate that interventions to improve compliance among kidney transplant recipients should strive for high rather than discourage low compliance.
authors.affiliation: Department of Internal Medicine, Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA. sktakemoto@hotmail.com
authors.forename: S K
authors.initials: SK
authors.lastname: Takemoto
authors.forename: B W
authors.initials: BW
authors.lastname: Pinsky
authors.forename: M A
authors.initials: MA
authors.lastname: Schnitzler
authors.forename: K L
authors.initials: KL
authors.lastname: Lentine
authors.forename: L M
authors.initials: LM
authors.lastname: Willoughby
authors.forename: T E
authors.initials: TE
authors.lastname: Burroughs
authors.forename: S
authors.initials: S
authors.lastname: Bunnapradist
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D016030:Kidney Transplantation / Q000276:immunology*; D016015:Logistic Models; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010349:Patient Compliance / Q000523:psychology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid