title: Medication adherence in the transition of adolescent kidney transplant recipients to the adult care.
abstract: Non-adherence is common in adolescent and young adult kidney transplant recipients, leading to adverse graft outcomes. The aim of this study was to determine whether adherence to immunosuppressant medications changes during transition from a pediatric to an adult program within the same transplant center. Adherence was assessed for a period of two yr before and two yr after the transfer. Subtherapeutic trough levels of serum tacrolimus and level variability were used as measures of adherence. Twenty-five patients were transitioned between 1996 and 2011 at the median age of 22.3 [IQR 21.6-23.0] yr. Young adults 21-25 yr of age (n = 26) and non-transitioned adolescents 17-21 yr of age (currently followed in the program, n = 24 and those that lost their grafts prior to the transfer, 22) formed the comparison groups. In the transitioned group, adherence prior to the transfer was not significantly different from the adherence after the transfer (p = 0.53). The rate of non-adherence in the group of non-transitioned adolescents who lost their grafts (68%) was significantly higher than in the transitioned group (32%, p = 0.01). In the group of young adults, adherence was not significantly different from the transitioned group (p = 0.27). Thus, transition was not associated with differences in medication adherence in this single-center study. Large-scale studies are needed to evaluate the national data on medication adherence after transfer.
authors.affiliation: Pediatrics, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Oleh M
authors.initials: OM
authors.lastname: Akchurin
authors.forename: Michal L
authors.initials: ML
authors.lastname: Melamed
authors.forename: Becky L
authors.initials: BL
authors.lastname: Hashim
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Kaskel
authors.forename: Marcela
authors.initials: M
authors.lastname: Del Rio
mesh_terms: D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood* / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D010372:Pediatrics; D051437:Renal Insufficiency / Q000601:surgery*; D012189:Retrospective Studies; D016559:Tacrolimus / Q000097:blood* / Q000627:therapeutic use; D060305:Transition to Adult Care; D066027:Transplant Recipients; D016896:Treatment Outcome; D014505:Urban Population; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus
keywords: adolescents; medication; non-adherence; pediatric kidney transplantation; transition