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BMC Nephrology
Published in: BMC Nephrology 1/2019

Open Access 01-12-2019 | Muromonab | Research article

Association of medication non-adherence with short-term allograft loss after the treatment of severe acute kidney transplant rejection

Authors: Ahmed Al-Sheyyab, Laura Binari, Mohammed Shwetar, Everly Ramos, Meghan E. Kapp, Stefanie Bala, Nikita Wilson, Rachel C. Forbes, J. Harold Helderman, Khaled Abdel-Kader, Beatrice P. Concepcion

Published in: BMC Nephrology | Issue 1/2019

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Abstract

Background

Medication non-adherence is a risk factor for acute kidney transplant rejection. The association of non-adherence with short-term allograft loss in patients who develop acute rejection and are subsequently treated with maximal therapy is unknown.

Methods

We conducted a retrospective single center cohort study of adult patients who developed acute rejection from January 2003 to December 2017 and were treated with lymphocyte depletion. Clinicopathologic characteristics including adherence status were collected and descriptive statistics utilized to compare groups. The primary outcome was all-cause graft loss at 6 months after acute rejection treatment. A multivariable logistic regression quantified the association of non-adherence with the outcome.

Results

A total of 182 patients were included in the cohort, of whom 71 (39%) were non-adherent. Compared to adherent patients, non-adherent patients were younger (mean age 37y vs 42y), more likely to be female (51% vs 35%) and developed acute rejection later (median 2.3y vs 0.5y from transplant). There were no differences in estimated glomerular filtration rate or need for dialysis on presentation, Banff grade, or presence of antibody mediated rejection between the 2 groups. Overall, 48 (26%) patients lost their grafts at 6 months after acute rejection treatment. In adjusted analysis, non-adherence was associated with all-cause graft loss at 6 months after acute rejection treatment [OR 2.64 (95% CI 1.23–5.65, p = 0.012].

Conclusions

After adjusting for common confounders, non-adherent patients were at increased risk for short-term allograft loss after a severe acute rejection despite lymphocyte depletion. This finding may aid clinicians in risk stratifying patients for poor short-term outcomes and treatment futility.
Appendix
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Metadata
Title
Association of medication non-adherence with short-term allograft loss after the treatment of severe acute kidney transplant rejection
Authors
Ahmed Al-Sheyyab
Laura Binari
Mohammed Shwetar
Everly Ramos
Meghan E. Kapp
Stefanie Bala
Nikita Wilson
Rachel C. Forbes
J. Harold Helderman
Khaled Abdel-Kader
Beatrice P. Concepcion
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Muromonab
Published in
BMC Nephrology / Issue 1/2019
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/s12882-019-1563-z

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