Patient Non-Adherence Predicts Worse Kidney Transplant Outcomes

Rates of non-adherence to follow-up care and medication regimens also found to differ by race.
Rates of non-adherence to follow-up care and medication regimens also found to differ by race.

Non-adherence to follow-up visits and medication regimens by kidney transplant recipients is associated with worse transplant outcomes, and rates of non-adherence differ by race, researchers from the Medical University of South Carolina in Charleston reported at the 2016 American Transplant Congress in Boston.

In a study of 1,410 kidney transplant recipients, Raghavesh Pullalarevu, MD, and collaborators found that 737 had documented adherence to laboratory assessments, clinic appointments, and medication regimens and 673 had documented non-adherence.

Compared with adherent patients, non-adherent patients had a significant 40% increased odds of acute rejection and 3-fold and 7.7-fold increased odds for second and third rejection episodes, respectively, Dr Pullalarevu's group found.

The non-adherent group had a significantly higher proportion of black patients than the adherence group (57% vs. 50%). The proportion of patients with a history of diabetes mellitus was significantly higher in the adherent than non-adherent group (36% vs. 30%).

“Targeting patients with risk factors related with non-adherence and instituting measures to improve adherence may have a positive impact on transplant outcomes,” the investigators concluded in their study abstract.

In another study, David J. Taber, PharmD, MS, and colleagues found that black kidney transplant recipients appear to have higher rates of early non-adherence than non-blacks, and these higher rates are driven mainly by missed appointments.

The study included 1,407 kidney transplant recipients, of whom 687 (53%) were black and 620 were not. The researchers observed non-adherence in 19.5% of the black patients within 1 year (18% non-adherent with appointments and 2.2% non-adherent with medications) compared with 12.1% of non-black patients, a significant difference between the groups. Black patients had 76% increased odds of non-adherence.

Early non-adherence was significantly associated with acute rejection and hospital readmission among black patients but not non-black patients.

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