Division of Nephrology, Department of Medicine, University of Tennessee, Memphis, TN, USA.
Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Am J Med Sci. 2021 Oct;362(4):381-386. doi: 10.1016/j.amjms.2021.05.011. Epub 2021 May 18.
Non-adherence is an important aspect of transplantation that affect outcomes. This study aims to investigate the impact of non-adherence to laboratory and clinic appointments on medication non-adherence and outcomes in kidney transplant (KT) recipients.
We analyzed KT recipients between 2005-14 with a detailed review of the medical records for non-adherence to laboratory and clinic appointments, as well as medication regimens. Baseline characteristics and clinical outcomes were compared between adherent and non-adherent groups.
A total of 1413 KT recipients were included: 754 who were adherent and 659 who were non-adherent. Non-adherent recipients tend to be younger, African American, and have private insurance. Adherent patients tend to have a history of DM, heart disease, and receive an ECD kidney. Non-adherence to appointments was a strong predictor of medication non-adherence (OR 3.1), acute rejection (OR 1.4), and subsequent rejection episodes (OR 3.3 and 8.1 respectively for ≥ 1 and ≥ 2 rejection episodes). Subset analysis of patients who had early non-adherence within 1-year post-transplant showed predominance of younger, African American patients. The same patients had higher prevalence of medication non-compliance, overall and ≥ 1-year post-transplant, and mean number of readmissions. Kaplan-Meier analysis showed a trend towards lower graft survival in this group.
Early non-adherence to laboratory and clinic appointments is a strong predictor of late medication non-adherence, acute rejection, and graft loss. Targeting patients that demonstrate early non-adherence to appointments with focused interventions may help improve kidney transplant outcomes in this high risk group.
不依从是移植的一个重要方面，会影响结果。本研究旨在探讨肾移植（KT）受者不依从实验室和临床预约对药物不依从和结局的影响。
我们分析了 2005-14 年间的 KT 受者，详细回顾了实验室和临床预约以及药物治疗方案的不依从情况。比较了依从组和不依从组的基线特征和临床结局。
共纳入 1413 例 KT 受者：754 例依从，659 例不依从。不依从受者倾向于年轻、非裔美国人，且有私人保险。依从患者往往有糖尿病、心脏病史，并接受 ECD 肾脏。不依从预约是药物不依从（OR3.1）、急性排斥（OR1.4）和随后排斥发作（OR3.3 和 8.1，分别用于≥1 和≥2 次排斥发作）的强烈预测因子。对移植后 1 年内早期不依从的患者进行亚组分析，显示年轻、非裔美国人患者居多。这些患者药物不依从的总体发生率和≥1 年移植后发生率以及平均再入院次数均较高。Kaplan-Meier 分析显示该组移植物存活率呈下降趋势。
早期不依从实验室和临床预约是晚期药物不依从、急性排斥和移植物丢失的强烈预测因子。针对表现出早期不依从预约的患者进行有针对性的干预，可能有助于改善该高危人群的肾移植结局。
