title: Patient-reported non-adherence and immunosuppressant trough levels are associated with rejection after renal transplantation.
abstract: BACKGROUND
  Different measures of non-adherence to immunosuppressant (IS) medication have been found to be associated with rejection episodes after successful transplantation. The aim of the current study was to investigate whether graft rejection after renal transplantation is associated with patient-reported IS medication non-adherence and IS trough level variables (IS trough level variability and percentage of sub-therapeutic IS trough levels).
  
  
  METHODS
  Patient-reported non-adherence, IS trough level variability, percentage of sub-therapeutic IS trough levels, and acute biopsy-proven late allograft rejections were assessed in 267 adult renal transplant recipients who were ≥12 months post-transplantation.
  
  
  RESULTS
  The rate of rejection was 13.5%. IS trough level variability, percentage of sub-therapeutic IS trough levels as well as patient-reported non-adherence were all significantly and positively associated with rejection, but not with each other. Logistic regression analyses revealed that only the percentage of sub-therapeutic IS trough levels and age at transplantation remained significantly associated with rejection.
  
  
  CONCLUSIONS
  Particularly, the percentage of sub-therapeutic IS trough levels is associated with acute rejections after kidney transplantation whereas IS trough level variability and patient-reported non-adherence seem to be of subordinate importance. Patient-reported non-adherence and IS trough level variables were not correlated; thus, non-adherence should always be measured in a multi-methodological approach. Further research concerning the best combination of non-adherence measures is needed.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Scheel
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Reber
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
authors.forename: Lisa
authors.initials: L
authors.lastname: Stoessel
authors.affiliation: Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander, University Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Waldmann
authors.affiliation: Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Jank
authors.affiliation: Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
authors.forename: Kai-Uwe
authors.initials: KU
authors.lastname: Eckardt
authors.affiliation: Department II of Internal Medicine, Nephrology, Rheumatology, Diabetes and General Internal Medicine, University Hospital of Cologne, Cologne, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Grundmann
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Cologne, Cologne, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Vitinius
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: de Zwaan
authors.affiliation: Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Bertram
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany. yesim.erim@uk-erlangen.de.
authors.forename: Yesim
authors.initials: Y
authors.lastname: Erim
mesh_terms: D004305:Dose-Response Relationship, Drug; D005260:Female; D005858:Germany / Q000453:epidemiology; D006084:Graft Rejection / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000601:surgery*; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D000071066:Patient Reported Outcome Measures; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D016903:Drug Monitoring
chemical_list: D007166:Immunosuppressive Agents
keywords: Immunosuppressant trough level variability; Kidney transplantation; Patient-reported non-adherence; Rejection; Sub-therapeutic immunosuppressant trough levels