Quantitative patterns of azathioprine adherence after renal transplantation.
BACKGROUND
Renal transplant recipients regularly fail to take their prescribed immunosuppressive medications, frequently leading to adverse outcomes.


METHODS
Medication vials incorporating electronic monitor circuits in their caps compiled prospective data files on the azathioprine dosing patterns of 180 adult renal transplant recipients monitored up to 4 years. These patients were followed for a mean of 8.7 years posttransplantation.


RESULTS
Patients were divided into three groups by the medication doses missed during the first 6 months posttransplant. These initial dosing patterns remained remarkably consistent up to 4 years. Patients (n=47) missing the most doses (>or=5%) experienced earlier and more frequent acute rejection episodes (P=0.025). This group also demonstrated significantly longer interdose intervals (P=0.005), with more frequent (P<0.001) and longer (P<0.001) "drug holidays." A patient subgroup with early declining medication adherence (n=23) experienced dramatically poorer outcomes, with significantly increased acute rejection (P<0.001), chronic rejection (P=0.034), graft loss before death (P<0.001), and death (P=0.04). In all tertiles there was a trend toward missing more medication over time.


CONCLUSIONS
Excellent posttransplant medication adherence is critical to improved outcomes. Individual dosing patterns are established early after hospital discharge and remain remarkably consistent, despite gradual erosion in adherence over time. The later consequences of medication nonadherence, especially early declines in adherence, include increased frequencies of rejection, graft loss, and death.
Nevins
Thomas E
TE
Department of Pediatrics, Division of Pediatric Nephrology, University of Minnesota School of Medicine, Minneapolis, MN 55108, USA. nevin001@umn.edu
Thomas
William
W
D001379:Azathioprine / Q000008:administration & dosage / Q000627:therapeutic use*; D004282:Documentation; D016903:Drug Monitoring / Q000379:methods; D004581:Electronics; D006084:Graft Rejection / Q000453:epidemiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology* / Q000523:psychology; D010349:Patient Compliance; D018579:Patient Selection; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D001379:Azathioprine