Department of Nutrition, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
Ann Transplant. 2021 Mar 30;26:e928356. doi: 10.12659/AOT.928356.
BACKGROUND Non-adherence to immunosuppressant therapy (IST) is a major risk factor for graft rejection. Limited reports are available regarding the prevalence of non-adherence to IST in kidney transplant recipients (KTRs) as well as the predictors and barriers of non-adherence. MATERIAL AND METHODS The study included ambulatory KTRs, ≥18 years of age, with a functional kidney, from January 2017 to November 2018. The primary outcome was the prevalence of non-adherence, assessed with: 1) A telephone interview to complete the Arabic-translated and validated Immunosuppressant Therapy Adherence Instrument Scale (ITAS) and 2) IST serum blood levels within therapeutic levels. The secondary outcomes were the barriers to adherence using the validated Immunosuppressant Therapy Barriers of Adherence Scale (ITBS). RESULTS We enrolled 102 of 141 patients screened. The mean±SD for age, body mass index, and the baseline of the estimated glomerular filtration rate were 45.5±15.6 years, 29.1±6 kg/m², and 72.7±21.9 ml/min/1.73 m², respectively. The prevalence of non-adherence was 5.9%, 95% CI (2.19-12.36%) and 14.7%, 95% CI (8.47-23.09%) using the ITAS and the average blood serum drug levels, respectively. The concordance of the 2 methods demonstrated an agreement of 81.3%, kappa of 0.01, and 95% CI (-0.16 to 0.18). The median, interquartile range (IQR) for ITBS, and uncontrollable and controllable barriers for adherence were 21, (18-25), 15, (12-18), and 6, (5-8), respectively. CONCLUSIONS The current study demonstrated a low to moderate prevalence of non-adherence to IST in KTRs. The barriers for adherence with IST necessitate additional targeted interventions to manage and optimize therapeutic and clinical outcomes.
免疫抑制剂治疗（IST）依从性差是移植物排斥的主要危险因素。关于肾移植受者（KTR）IST 依从性的流行率以及不依从的预测因素和障碍，仅有有限的报道。
本研究纳入了 2017 年 1 月至 2018 年 11 月期间门诊 KTR，年龄≥18 岁，有功能肾。主要结局是不依从 IST 的发生率，通过以下方法评估：1）电话访谈以完成阿拉伯语翻译并验证免疫抑制剂治疗依从性工具量表（ITAS）和 2）IST 血清血药浓度在治疗水平内。次要结局是使用验证的免疫抑制剂治疗依从性障碍量表（ITBS）评估依从性的障碍。
我们对 141 名筛查患者中的 102 名进行了入组。年龄、体重指数和估计肾小球滤过率基线的平均值±标准差分别为 45.5±15.6 岁、29.1±6kg/m²和 72.7±21.9ml/min/1.73m²。分别使用 ITAS 和平均血清药物水平，不依从 IST 的发生率为 5.9%（95%CI[2.19-12.36%]）和 14.7%（95%CI[8.47-23.09%]）。两种方法的一致性显示，一致性为 81.3%，kappa 值为 0.01，95%CI（-0.16 至 0.18）。ITBS 的中位数、四分位距（IQR）和依从性的不可控和可控障碍分别为 21（18-25）、15（12-18）和 6（5-8）。
本研究显示 KTR 对 IST 的依从性低至中度。IST 依从性障碍需要额外的针对性干预措施来管理和优化治疗和临床结果。
