Scheel Jennifer, Reber Sandra, Stoessel Lisa, Waldmann Elisabeth, Jank Sabine, Eckardt Kai-Uwe, Grundmann Franziska, Vitinius Frank, de Zwaan Martina, Bertram Anna, Erim Yesim
Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander, University Erlangen-Nürnberg, Erlangen, Germany.
BMC Nephrol. 2017 Mar 29;18(1):107. doi: 10.1186/s12882-017-0517-6.
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).
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.
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.
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.
已发现不同的免疫抑制剂（IS）用药不依从性衡量指标与移植成功后的排斥反应相关。本研究的目的是调查肾移植后的移植物排斥反应是否与患者报告的IS用药不依从性以及IS谷浓度变量（IS谷浓度变异性和低于治疗水平的IS谷浓度百分比）有关。
在267例移植后≥12个月的成年肾移植受者中评估患者报告的不依从性、IS谷浓度变异性、低于治疗水平的IS谷浓度百分比以及经活检证实的急性晚期移植肾排斥反应。
排斥反应发生率为13.5%。IS谷浓度变异性、低于治疗水平的IS谷浓度百分比以及患者报告的不依从性均与排斥反应显著正相关，但彼此之间无相关性。逻辑回归分析显示，只有低于治疗水平的IS谷浓度百分比和移植时的年龄仍与排斥反应显著相关。
特别是，低于治疗水平的IS谷浓度百分比与肾移植后的急性排斥反应相关，而IS谷浓度变异性和患者报告的不依从性似乎次要。患者报告的不依从性与IS谷浓度变量不相关；因此，应始终采用多方法来衡量不依从性。需要进一步研究不依从性衡量指标的最佳组合。
