Predictive patterns of early medication adherence in renal transplantation.
BACKGROUND
Patients' adherence with posttransplant immunosuppression is known to affect renal transplant outcomes.


METHODS
Prospectively, individual medication adherence patterns in 195 kidney transplant recipients were quantified with electronic medication monitors. Monitored drugs were mycophenolate mofetil, sirolimus, or azathioprine. Monitoring began at hospital discharge and continued an average of 15±8 months. Patient follow-up for clinical outcomes averaged 8±3 years. Each month's adherence percentage was calculated as the sum of daily adherence percents, divided by the number of evaluable days.


RESULTS
During the first 3 months after transplantation, patients (n=44) with declining medication adherence, defined as dropping by 7% or higher (equal to missing 2 days) between months 1 and 2, later experienced lower mean medication adherence for months 6 to 12, 73% versus 92% respectively (P<0.0001). Compared to patients with stable adherence, they also had more frequent (P=0.034) and earlier (P=0.065) acute rejection episodes. This was additionally associated with more frequent (P=0.017) and earlier (P=0.046) death-censored graft loss.In addition, daily medication adherence, expressed as the percentage of doses taken, decreased as the number of prescribed daily doses increased. During the first 3 months after transplantation, adherence with four doses per day averaged 84%, compared to 91% for patients on twice-daily dosing (P=0.024) and 93.5% for patients on once-daily dosing (P=0.008).


CONCLUSIONS
Early declining medication nonadherence is associated with adverse clinical outcomes. This pattern is detectable during the first 2 months after transplantation. Early detection of nonadherence provides opportunities to target interventions toward patients at the highest risk for adverse behaviors and events.
1 Division of Pediatric Nephrology, Department of Pediatrics, University of Minnesota Medical School, Amplatz Children's Hospital, Minneapolis, MN. 2 Departments of Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, MN. 3 Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN. 4 Address correspondence to: Thomas E. Nevins, M.D., Division of Nephrology, Department of Pediatrics, 420 Delaware St SE, 13-152 Phillips-Wangensteen Bldg, Minneapolis, MN 55455.
Thomas E
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D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011446:Prospective Studies
D007166:Immunosuppressive Agents