title: The Impact of Health Care Appointment Non-Adherence on Graft Outcomes in Kidney Transplantation.
abstract: Non-adherence to medication is a well-studied and known cause of late allograft loss, but it is difficult to measure and prospectively monitor. The aim of this study was to assess if appointment non-adherence was correlated with medication non-adherence and a predictor of graft outcomes.
  
  
  
  This was a longitudinal cohort study that used the National United States Renal Data System and veterans affairs health records data with time-to-event analyses conducted to assess the impact on graft and patient survival.
  
  
  
  The number of transplants that were included in the analysis was 4,646 (3,656 with complete records); 14.6% of patients had an appointment no show rate of ≥12% (non-adherence). Appointment and medication non-adherence were highly correlated and both were significant independent predictors of outcomes. Those with appointment non-adherence had 1.5 times the risk of acute rejection (22.0 vs. 14.7%, p < 0.0001) and a 65% higher risk of graft loss (adjusted hazards ratio (aHR) 1.65, 95% CI 1.38-1.97, p < 0.0001). There was a significant interaction between appointment and medication non-adherence; those with appointment and medication non-adherence were at very high risk of graft loss (aHR 4.18, 95% CI 3.39-5.15, p < 0.0001), compared to those with only appointment non-adherence (aHR 1.39, 95% CI 0.97-2.01, p = 0.0766) or only medication non-adherence (aHR 2.44, 95% CI 2.11-2.81, p < 0.0001).
  
  
  
  These results demonstrate that non-adherence to health care appointments is a significant and independent risk factor for graft loss.
authors.affiliation: Division of Transplant Surgery, College of Medicine, Medical University of South Carolina, Charleston, S.C., USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Taber
authors.forename: James N
authors.initials: JN
authors.lastname: Fleming
authors.forename: Cory E
authors.initials: CE
authors.lastname: Fominaya
authors.forename: Mulugeta
authors.initials: M
authors.lastname: Gebregziabher
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Hunt
authors.forename: Titte R
authors.initials: TR
authors.lastname: Srinivas
authors.forename: Prabhakar K
authors.initials: PK
authors.lastname: Baliga
authors.forename: John W
authors.initials: JW
authors.lastname: McGillicuddy
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
mesh_terms: D000368:Aged; D001071:Appointments and Schedules; D051799:Delayed Graft Function / Q000453:epidemiology; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D000067455:No-Show Patients / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D014728:Veterans; D016903:Drug Monitoring
chemical_list: D007166:Immunosuppressive Agents