Zhi-Yu Zou, Lin-Rui Dai, Chen-Zhen Yu, Ren-Jie Chen, Fei-Hong Yu, Song Chen, Sheng Chang, Wei-Jie Zhang
Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education, NHC Key Laboratory of Organ Transplantation, Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China.
Kidney Transplant Department, Organ Transplant Center, Third People's Hospital of Shenzhen, The Second Affiliated Hospital, Southern University of Science and Technology, National Clinical Research Center for Infectious Disease, Shenzhen, China.
Front Pharmacol. 2024 Dec 18;15:1493166. doi: 10.3389/fphar.2024.1493166. eCollection 2024.
Despite the fact that 1-year graft and recipient survival rates are above 90% in most transplant centers, improving long-term graft survival remains an important challenge. Immunosuppressant nonadherence has been recognized as one of the important risk factors for long-term graft failure. Understanding the modifiable correlates and risk factors for medication non-adherence is essential to develop interventions to improve adherence and thus long-term transplantation outcomes.
This study conducted a questionnaire survey on 431 renal transplant recipients who were followed up in the outpatient clinic between January 2022 and January 2023, and 409 valid questionnaires were returned. The BAASIS questionnaire was used to assess the prevalence of nonadherence to immunosuppressive therapy (implementation phase) in Chinese renal transplant recipients and to explore the multilevel correlates of immunosuppressive nonadherence. The BAASIS questionnaire was used to categorize renal transplant recipients into adherent (n = 239) and non-adherent (n = 170) groups, and a prospective cohort study with a 1-year follow-up was conducted to explore the impact of immunosuppressant non-adherence on clinical outcomes.
The prevalence of nonadherence to immunosuppressant therapy in renal transplant recipients in this study was as high as 41.6%. The number of years post-transplant (OR: 1.240, 95% CI: 1.136-1.353, < 0.001) and the frequency of twice-daily dosing (OR: 5.145, 95% CI: 2.690-9.840, < 0.001) were positively correlated with immunosuppressive nonadherence. There was a significant difference in TAC IPV (Intra-individual Variability) between the adherent and nonadherent groups (22.7 ± 8.7 vs. 25.4 ± 11.6, = 0.010). Renal function remained stable during the follow-up period in the recipients in the adherence group and tended to decrease in the recipients in the non-adherence group (F = 4.932, = 0.001). The rates of graft loss (7.1% vs. 1.7%, = 0.006) and rejection (12.4% vs. 4.2%, = 0.002) were higher in the nonadherent group than in the adherent group.
Longer time post-transplant and higher frequency of immunosuppressive dosing were positively associated with nonadherence to immunosuppressives medication. Immunosuppressant nonadherence was associated with adverse graft outcomes.
尽管在大多数移植中心，1年移植物和受者存活率高于90%，但提高长期移植物存活率仍然是一项重大挑战。免疫抑制剂不依从已被认为是长期移植物失败的重要风险因素之一。了解药物不依从的可改变相关因素和风险因素对于制定干预措施以提高依从性从而改善长期移植结局至关重要。
本研究对2022年1月至2023年1月在门诊随访的431例肾移植受者进行了问卷调查，共回收有效问卷409份。采用BAASIS问卷评估中国肾移植受者免疫抑制治疗（实施阶段）不依从的患病率，并探讨免疫抑制不依从的多层次相关因素。使用BAASIS问卷将肾移植受者分为依从组（n = 239）和不依从组（n = 170），并进行了为期1年随访的前瞻性队列研究，以探讨免疫抑制剂不依从对临床结局的影响。
本研究中肾移植受者免疫抑制治疗不依从的患病率高达41.6%。移植后年限（比值比：1.240，95%置信区间：1.136 - 1.353，P < 0.001）和每日两次给药频率（比值比：5.145，95%置信区间：2.690 - 9.840，P < 0.001）与免疫抑制不依从呈正相关。依从组和不依从组的他克莫司个体内变异性（TAC IPV）存在显著差异（22.7 ± 8.7 vs. 25.4 ± 11.6，P = 0.010）。随访期间，依从组受者肾功能保持稳定，不依从组受者肾功能有下降趋势（F = 4.932，P = 0.001）。不依从组的移植物丢失率（7.1% vs. 1.7%，P = 0.006）和排斥反应率（12.4% vs. 4.2%，P = 0.002）高于依从组。
移植后时间越长和免疫抑制给药频率越高与免疫抑制剂药物不依从呈正相关。免疫抑制剂不依从与不良的移植物结局相关。
