Electronically measured adherence to immunosuppressive medications and kidney function after deceased donor kidney transplantation.
BACKGROUND
Non-adherence with immunosuppressive medications can result in allograft rejection and eventually allograft loss.


METHODS
In a racially diverse population, we utilized microelectronic cap monitors to determine the association of adherence with a single immunosuppressive medication and kidney allograft outcomes post-transplantation. This prospective cohort study enrolled 243 patients from eight transplant centers to provide adherence and kidney allograft outcomes data. To determine the association of adherence with change in estimated glomerular filtration rate (eGFR), we fit mixed effects models with the outcome being change in eGFR over time. We also fit Cox proportional hazards models to determine the association of adherence with time to persistent 25% and 50% decline in eGFR.


RESULTS
The distribution of adherence post-transplant was as follows: 164 (68%), 49 (20%), and 30 (12%) had >85-100%, 50-85%, and <50% adherence, respectively. Seventy-nine (33%) and 36 (15%) of the subjects experienced a persistent 25% decline in eGFR or allograft loss and 50% decline in eGFR or allograft loss during follow-up. Adherence was not associated with acute rejection or 25% decline or 50% decline in eGFR. In the adjusted and unadjusted model, adherence and black race were not associated with change in eGFR over time.


CONCLUSIONS
Non-adherence with a single immunosuppressive medication was not associated with kidney allograft outcomes.
Israni
Ajay K
AK
Department of Medicine, Hennepin County Medical Center, University of Minnesota, 701 Park Avenue, Minneapolis, MN 55415-1829, USA. isran001@umn.e
Weng
Francis L
FL
Cen
Ye-Ying
YY
Joffe
Marshall
M
Kamoun
Malek
M
Feldman
Harold I
HI
D001741:Black or African American; D015331:Cohort Studies; D057286:Electronic Health Records; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011446:Prospective Studies; D044465:White People
D007166:Immunosuppressive Agents