Assessing Risk Factors and Posttransplant Outcomes of Nonadherence Among Kidney Transplant Recipients

Adherence of kidney transplant recipients (KTRs) to prescribed regimens is vital for long-term graft function. This study aimed to identify adherence rates using objective and composite measures, risk factors for nonadherence, and the latter's impact on posttransplant outcomes.

A retrospective single-center cohort study was conducted among KTR transplanted from January 1, 2003, to December 31, 2017. Overall nonadherence was defined as 1 or more of the following in the first-year posttransplant: (1) at least 1 missed clinic visit, (2) >30% missed laboratory visits, and (3) >40% coefficient of variation of calcineurin inhibitor levels. Logistic and Cox proportional hazards models were fitted to identify adherence risk factors and outcomes, respectively.

Among the included 1803 KTR, overall nonadherence was identified in 34.9%; 11.2% were nonadherent to clinic visits, 5.4% to laboratory tests, and 25.2% to medications. Recipient history of psychiatric disorders (odds artio [OR], 1.57; 95% confidence interval [CI], 1.22-2.02) or pretransplant nonadherence (OR, 1.82; 95% CI, 1.31-2.54), and private drug coverage (OR, 0.62; 95% CI, 0.48-0.80) were associated with posttransplant nonadherence. Any episode of nonadherence over the first year after transplant was associated with an increased risk of total graft failure (hazard ratio [HR], 1.52; 95% CI, 1.20-1.91), death with graft function (HR, 1.51; 95% CI, 1.11-2.05), and biopsy-proven acute rejection (HR, 2.35; 95% CI, 1.38-3.99).

Adherence among KTR is influenced by both psychosocial and socioeconomic determinants which impact posttransplant outcomes. Our results emphasize feasible methods to monitor adherence and identify high-risk KTR.