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Open Access 01-12-2017 | Research article

Patient-reported non-adherence and immunosuppressant trough levels are associated with rejection after renal transplantation

Authors: Jennifer Scheel, Sandra Reber, Lisa Stoessel, Elisabeth Waldmann, Sabine Jank, Kai-Uwe Eckardt, Franziska Grundmann, Frank Vitinius, Martina de Zwaan, Anna Bertram, Yesim Erim

Published in: BMC Nephrology | Issue 1/2017

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.

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Title: Patient-reported non-adherence and immunosuppressant trough levels are associated with rejection after renal transplantation
Authors: Jennifer Scheel
Sandra Reber
Lisa Stoessel
Elisabeth Waldmann
Sabine Jank
Kai-Uwe Eckardt
Franziska Grundmann
Frank Vitinius
Martina de Zwaan
Anna Bertram
Yesim Erim
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: BMC Nephrology / Issue 1/2017
Electronic ISSN: 1471-2369
DOI: https://doi.org/10.1186/s12882-017-0517-6

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Patient-reported non-adherence and immunosuppressant trough levels are associated with rejection after renal transplantation

Abstract

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Methods

Results

Conclusions

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