Prediction of medication non-adherence and associated outcomes in pediatric kidney transplant recipients

Area of Science:

• Pediatric Nephrology
• Transplant Medicine
• Adherence Research

Background:

• Post-transplant non-adherence is a significant issue in pediatric kidney transplant recipients.
• Existing studies often identify risk factors but lack predictive models for medication non-adherence (MNA).

Purpose of the Study:

• To identify key risk factors for MNA in pediatric kidney transplant (KTX) recipients.
• To develop a predictive risk model for MNA.
• To evaluate the impact of MNA on transplant outcomes.

Main Methods:

• Retrospective analysis of 175 pediatric KTX recipients transplanted between 1999 and 2013.
• Logistic regression analysis to develop a predictive model for MNA using identified risk factors.
• Comparison of transplant outcomes (rejection, hospitalization, graft loss) between patients with and without MNA.

Main Results:

• Risk factors for MNA included African American race, male sex, older age, urban residence, legal issues, and proximity to the transplant center.
• A nine-factor predictive model achieved a positive predictive value of 69% and a negative predictive value of 81%.
• MNA was associated with a >2-fold increased risk of acute rejection, 1.6-fold increased risk of hospitalization, and 1.8-fold increased risk of graft loss.

Conclusions:

• A predictive model can effectively identify pediatric KTX recipients at risk for MNA.
• Early identification and intervention for MNA can potentially improve long-term transplant outcomes.
• This model offers a tool for clinicians to proactively monitor and manage MNA.