Prediction of medication non-adherence and associated outcomes in pediatric kidney transplant recipients.
Studies have continued to evaluate risk factors associated with post-transplant non-adherence in pediatric patients. However, many of these studies fail to evaluate how risk factors can be utilized to predict MNA. The aims of this study were to (i) determine salient risk factors associated with MNA to develop an adequate predictive risk model and (ii) assess transplant outcomes based on the presence of MNA in a large, diverse cohort of pediatric KTX recipients. One hundred and seventy-five solitary pediatric KTX recipients transplanted from 1999 to 2013 were included. AA, males, older patients, those who lived in urban environments, had legal issues, and lived shorter distances from the transplant center were more likely to have MNA. Using logistic regression, a parsimonious model applying nine risk factors together was developed for predicting MNA, demonstrating a PPV of 69% and a NPV of 81%. Patients with MNA had more than twice the risk of biopsy proven acute rejection, 1.6 times the risk of hospitalization, and 1.8 times the risk of graft loss. Utilization of a predictive model to determine risk of MNA after pediatric KTX may offer clinicians the ability to efficiently and effectively monitor MNA following transplant.
Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA.|Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
James
J
Connelly
Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
N
N
Pilch
Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
M
M
Oliver
Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
C
C
Jordan
Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
J
J
Fleming
Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
H
H
Meadows
Division of Transplant Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
P
P
Baliga
Division of Transplant Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
S
S
Nadig
Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
K
K
Twombley
College of Nursing, Medical University of South Carolina, Charleston, SC, USA.
I
I
Shatat
Division of Transplant Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
D
D
Taber
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006297:Health Services Accessibility; D006760:Hospitalization; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D016030:Kidney Transplantation; D008297:Male; D055118:Medication Adherence; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D066027:Transplant Recipients; D016896:Treatment Outcome; D014505:Urban Population; D055815:Young Adult
D007166:Immunosuppressive Agents
medication non-adherence; pediatric kidney transplant; rejection; risk factors