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Vinson AJ, Zhang X, Dahhou M, Süsal C, Döhler B, Melk A, Sapir-Pichhadze R, Cardinal H, Wong G, Francis A, Pilmore H, Grinspan LT, Foster BJ. Differences in excess mortality by recipient sex after heart transplant: An individual patient data meta-analysis. J Heart Lung Transplant 2024:S1053-2498(24)01536-5. [PMID: 38522764 DOI: 10.1016/j.healun.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/07/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Identification of differences in mortality risk between female and male heart transplant recipients may prompt sex-specific management strategies. Because worldwide, males of all ages have higher absolute mortality rates than females, we aimed to compare the excess risk of mortality (risk above the general population) in female vs male heart transplant recipients. METHODS We used relative survival models conducted separately in SRTR and CTS cohorts from 1988-2019, and subsequently combined using 2-stage individual patient data meta-analysis, to compare the excess risk of mortality in female vs male first heart transplant recipients, accounting for the modifying effects of donor sex and recipient current age. RESULTS We analyzed 108,918 patients. When the donor was male, female recipients 0-12 years (Relative excess risk (RER) 1.13, 95% CI 1.00-1.26), 13-44 years (RER 1.17, 95% CI 1.10-1.25), and ≥45 years (RER 1.14, 95% CI 1.02-1.27) showed higher excess mortality risks than male recipients of the same age. When the donor was female, only female recipients 13-44 years showed higher excess risks of mortality than males (RER 1.09, 95% CI 1.00-1.20), though not significantly (p = 0.05). CONCLUSIONS In the setting of a male donor, female recipients of all ages had significantly higher excess mortality than males. When the donor was female, female recipients of reproductive age had higher excess risks of mortality than male recipients of the same age, though this was not statistically significant. Further investigation is required to determine the reasons underlying these differences.
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Affiliation(s)
- Amanda J Vinson
- Department of Medicine, Nephrology Division, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Xun Zhang
- Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Mourad Dahhou
- Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Caner Süsal
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany; Transplant Immunology Research Center of Excellence, Koç University, Istanbul, Turkey
| | - Bernd Döhler
- Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Anette Melk
- Children's Hospital, Hannover Medical School, Hannover, Germany
| | - Ruth Sapir-Pichhadze
- Department of Medicine, Division of Nephrology, McGill University, Montreal, Quebec, Canada
| | - Heloise Cardinal
- Department of Medicine, Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anna Francis
- School of Clinical Medicine, University of Queensland, Brisbane, Australia; Department of Nephrology, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Helen Pilmore
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Lauren T Grinspan
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bethany J Foster
- Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Pediatrics, Division of Nephrology, McGill University Faculty of Medicine, Montreal, Quebec, Canada
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Chambord J, Chauveau B, Djabarouti S, Vignaud J, Taton B, Moreau K, Visentin J, Merville P, Xuereb F, Couzi L. Measurement of the Immunosuppressant Possession Ratio by Transplant Clinical Pharmacists Captures a Non-Adherence Associated With Antibody-Mediated Rejection. Transpl Int 2023; 36:11962. [PMID: 38089004 PMCID: PMC10713790 DOI: 10.3389/ti.2023.11962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023]
Abstract
Our objective was to calculate an immunosuppressant possession ratio (IPR) to diagnose non-adherence at the time of antibody-mediated rejection (ABMR). IPR was defined as the ratio of number of pills collected at the pharmacy to the number of pills prescribed over a defined period. In a first cohort of 91 kidney transplant recipients (KTRs), those with an IPR < 90% had more frequently a tacrolimus through level coefficient of variation >30% than patients with an IPR = 100% (66.7% vs. 29.4%, p = 0.05). In a case-control study, 26 KTRs with ABMR had lower 6 months IPRs than 26 controls (76% vs. 99%, p < 0.001). In KTRs with ABMR, non-adherence was more often diagnosed by a 6 months IPR < 90% than by clinical suspicion (73.1% vs 30.8%, p = 0.02). In the multivariable analysis, only de novo DSA and 6 months IPR < 90% were independently associated with ABMR, whereas clinical suspicion was not (odds ratio, 4.73; 95% CI, 1.17-21.88; p = 0.03; and odds ratio, 6.34; 95% CI, 1.73-25.59; p = 0.007, respectively). In summary, IPR < 90% is a quantifiable tool to measure immunosuppressant non-adherence. It is better associated with ABMR than clinical suspicion of non-adherence.
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Affiliation(s)
- Jérémy Chambord
- Service de Pharmacie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Bertrand Chauveau
- Service d’Anatomopathologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- CNRS-UMR 5164 ImmunoConcEpT, Université de Bordeaux, Bordeaux, France
| | - Sarah Djabarouti
- Service de Pharmacie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- INSERM U1312 BRIEC, Université de Bordeaux, Bordeaux, France
| | - Jean Vignaud
- Service de Pharmacie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Benjamin Taton
- Service de Néphrologie, Transplantation, Dialyse, Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Karine Moreau
- Service de Néphrologie, Transplantation, Dialyse, Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Jonathan Visentin
- CNRS-UMR 5164 ImmunoConcEpT, Université de Bordeaux, Bordeaux, France
- Service d’Immunologie et Immunogénétique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Pierre Merville
- CNRS-UMR 5164 ImmunoConcEpT, Université de Bordeaux, Bordeaux, France
- Service de Néphrologie, Transplantation, Dialyse, Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Fabien Xuereb
- Service de Pharmacie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- INSERM U1034, Université de Bordeaux, Bordeaux, France
| | - Lionel Couzi
- CNRS-UMR 5164 ImmunoConcEpT, Université de Bordeaux, Bordeaux, France
- Service de Néphrologie, Transplantation, Dialyse, Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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3
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Jang HY, Kim YS, Oh JM. Clinical Effectiveness of Renal Transplant Outpatient Pharmaceutical Care Services in Korea. Healthcare (Basel) 2023; 11:2597. [PMID: 37761794 PMCID: PMC10531252 DOI: 10.3390/healthcare11182597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The necessity and importance of pharmaceutical care services (PCS) are well recognized, yet the concept and scope of PCS have not yet been clearly defined in Korea, particularly in kidney transplantation outpatient clinics. AIM The main purpose of this study is to evaluate whether PCS is effective in the outpatient setting for kidney transplant patients. METHODS For three years, a clinical pharmacist provided PCS to kidney transplant patients in an outpatient setting to evaluate the clinical effectiveness of PCS. RESULTS A total of 302 patients were matched in a 1:1 ratio, with 151 in the PCS group and 151 in the control group. These patients were followed, and a total of 476 interventions were provided to them, including medication reconciliation (n = 113, 23.7%), medication evaluation and management (n = 186, 39.1%), and pharmaceutical care transition (n = 177, 37.2%) services. The estimated glomerular filtration rate (eGFR) exhibited a notable difference between the control and PCS groups when comparing the pre- and post-study periods measurements. In the control group, there was a decline of 7.0 mL/min/1.73 m2 in eGFR. In contrast, the PCS group showed a smaller decline of 2.5 mL/min/1.73 m2 (p = 0.03). The adjusted odds ratio for end stage renal disease development in the PCS group was 0.51 (95% confidence interval: 0.26-0.96), indicating a significantly lower risk compared to the control group. CONCLUSION Our study highlights the promising potential of PCS implementation in kidney transplantation outpatient clinics. Further research is needed to validate and expand upon these findings, especially in diverse clinical settings.
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Affiliation(s)
- Ha Young Jang
- College of Pharmacy, Gachon University, Incheon 21936, Republic of Korea;
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea;
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Jung Mi Oh
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea
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Vaisbourd Y, Dahhou M, Zhang X, Sapir-Pichhadze R, Cardinal H, Johnston O, Blydt-Hansen TD, Tibbles LA, Hamiwka L, Urschel S, Birk P, Bissonnette J, Matsuda-Abedini M, BScPhm JH, Schiff J, Phan V, De Geest S, Allen U, Avitzur Y, Mital S, Foster BJ. Differences in medication adherence by sex and organ type among adolescent and young adult solid organ transplant recipients. Pediatr Transplant 2023; 27:e14446. [PMID: 36478059 DOI: 10.1111/petr.14446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Identification of differences in medication adherence by sex or organ type may help in planning interventions to optimize outcomes. We compared immunosuppressive medication adherence between males and females, and between kidney, liver and heart transplant recipients. METHODS This multicenter study of prevalent kidney, liver and heart transplant recipients 14-25 years assessed adherence 3 times (0, 3, 6 months post-enrollment) with the BAASIS self-report tool. At each visit, participants were classified as adherent if they missed no doses in the prior 4 weeks and non-adherent otherwise. Adherence was also assessed using the coefficient of variation (CV) of tacrolimus trough levels; CV < 30% was classified as adherent. We used multivariable mixed effects logistic regression models adjusted for potential confounders to compare adherence by sex and by organ. RESULTS Across all visits, males (n = 150, median age 20.4 years, IQR 17.2-23.3) had lower odds of self-reported adherence than females (n = 120, median age 19.8 years, IQR 17.1-22.7) (OR 0.41, 95% CI 0.21-0.80) but higher odds of adherence by tacrolimus CV (OR 2.50, 95% CI 1.30-4.82). No significant differences in adherence (by self-report or tacrolimus CV) were noted between the 184 kidney, 58 liver, and 28 heart recipients. CONCLUSION Females show better self-reported adherence than males but greater variability in tacrolimus levels. Social desirability bias, more common in females than males, may contribute to better self-reported adherence among females. Higher tacrolimus variability among females may reflect biologic differences in tacrolimus metabolism between males and females rather than sex differences in adherence. There were no significant differences in adherence by organ type.
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Affiliation(s)
| | - Mourad Dahhou
- Research Institute of The McGill University Health Centre, Quebec, Canada
| | - Xun Zhang
- Research Institute of The McGill University Health Centre, Quebec, Canada
| | - Ruth Sapir-Pichhadze
- Research Institute of The McGill University Health Centre, Quebec, Canada.,Department of Medicine, McGill University, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada
| | | | - Olwyn Johnston
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tom D Blydt-Hansen
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lee Anne Tibbles
- Department of Medicine and Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lorraine Hamiwka
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simon Urschel
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Patricia Birk
- Section of Pediatric Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Mina Matsuda-Abedini
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Harrison BScPhm
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Ajmera Transplant Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Jeffrey Schiff
- Ajmera Transplant Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Sabina De Geest
- Department Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Department of Primary Care and Public Health, Academic Center of Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Upton Allen
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
| | - Yaron Avitzur
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
| | - Seema Mital
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
| | - Bethany J Foster
- Department of Pediatrics, McGill University, Quebec, Canada.,Research Institute of The McGill University Health Centre, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada
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5
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Lhermitte R, Le Daré B, Laval F, Lemaitre F, Troussier B, Morin MP, Vigneau C, Chemouny JM, Bacle A. A pharmacist-led intervention to improve kidney transplant recipient outcomes and identify patients at risk of highly variable trough tacrolimus levels: a cohort study. Eur J Hosp Pharm 2023:ejhpharm-2022-003625. [PMID: 36737230 DOI: 10.1136/ejhpharm-2022-003625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Given the positive impact of appropriate medication management on graft outcome and therefore of patient survival and graft function, the pharmacist's role in the kidney transplantation team has evolved over recent decades. The primary objective of this study was to determine whether pharmacist-led intervention after kidney transplantation is associated with a lower graft rejection rate and intra-patient variation in tacrolimus trough concentrations (Cmin). The study's secondary objective was to develop a questionnaire to identify patients at risk for highly variable Cmin. METHODS We retrospectively analysed kidney transplant recipients at Rennes University Hospital (France) between January 2013 and December 2020. Patients who received pharmacist-led education (intervention group, n=139) were compared with patients who did not (control group, n=131), according to graft survival at 1 year post-transplant, coefficient of variation (%CV) for the tacrolimus Cmin, age, sex, length of hospital stay post-transplantation, body mass index, and Charlson Comorbidity Index. In the intervention group, a questionnaire assessing patient knowledge was introduced to compare scores with the %CV. RESULTS In the intervention group, 1 year post-transplant graft survival was higher (95.7% vs 88.5%, p=0.0289) and patients had fewer variabilities in Cmin. The %CV was correlated with questionnaire scores (r=-0.9758, p<0.0001). CONCLUSIONS Pharmacist-led interventions may have contributed to improved graft survival and patient management of immunosuppressants. Because %CV correlates with the patient questionnaire score, its introduction could be useful in identifying kidney transplant patients who would benefit most from a pharmacist-led patient education.
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Affiliation(s)
| | - Brendan Le Daré
- Service Hospitalo-Universitaire de Pharmacie, Rennes, France
- NuMeCan, Rennes, France
| | - Florian Laval
- Service Hospitalo-Universitaire de Pharmacie, Rennes, France
| | - Florian Lemaitre
- Department of Clinical and Biological Pharmacology and Pharmacovigilance, Clinical Investigation Center CIC-P 1414, Rennes, France
| | | | | | - Cécile Vigneau
- Univ Rennes, CHU Rennes, INSERM, EHESP, Irset-UMR_S 1085, 35000, Rennes, France, Rennes, France
| | - Jonathan M Chemouny
- Univ Rennes, CHU Rennes, INSERM, EHESP, Irset-UMR_S 1085, 35000, Rennes, France, Rennes, France
| | - Astrid Bacle
- Service Hospitalo-Universitaire de Pharmacie, Rennes, France
- Univ Rennes, CHU Rennes, INSERM, EHESP, Irset-UMR_S 1085, 35000, Rennes, France, Rennes, France
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6
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Dunbar JC, Bascom E, Pratt W, Snyder J, Smith JM, Pollack AH. My Kidney Identity: Contextualizing pediatric patients and their families kidney transplant journeys. Pediatr Transplant 2022; 26:e14343. [PMID: 35863916 DOI: 10.1111/petr.14343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/18/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Even though having a kidney transplant is the treatment of choice for children with kidney failure, it can cause anxiety for patients and their families resulting in decreased psychosocial functioning, adherence, and self-management. We set out to identify the information needs required to help pediatric patients and their families contextualize their posttransplant experiences as they recalibrate their understanding of normalcy throughout their transplant journey. METHODS Participants submitted photographs related to feeling: (1) worried, (2) confident, (3) similar to peers without kidney disease, and (4) different from these peers. The photographs served as a foundation for an in-depth interview. RESULTS Nineteen individuals (10 pediatric transplant recipients and 9 caregivers) were interviewed at a mean of 8 years posttransplant. We identified five specific themes and tensions our participants associated with recalibrating their version of "normal" throughout the transplant journey: (1) exchanging information (information consumers vs. information contributors, (2) transitional management (family management vs. self-management), (3) building confidence (worry vs. confidence), (4) telling one's story (hiding vs. self-expression), and (5) normalizing kidney transplantation (feeling different vs. feeling similar). These five themes/tensions form one's Kidney Identity, shift from negative to positive throughout the transplant journey, illustrating a more abstract and complex account of kidney transplantation over time. CONCLUSIONS Having a patient view their Kidney Identity over time may support self-reflection of one's progress posttransplant and potentially help clinicians, patients, and their caregivers identify barriers and areas where they may need more support to ensure their successful engagement in their care.
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Affiliation(s)
- Julia C Dunbar
- Information School, University of Washington, Seattle, Washington, USA
| | - Emily Bascom
- Information School, University of Washington, Seattle, Washington, USA
| | - Wanda Pratt
- Information School, University of Washington, Seattle, Washington, USA
| | - Jaime Snyder
- Information School, University of Washington, Seattle, Washington, USA
| | - Jodi M Smith
- Division of Nephrology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Ari H Pollack
- Information School, University of Washington, Seattle, Washington, USA.,Division of Nephrology, Seattle Children's Hospital, Seattle, Washington, USA
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7
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Varnell CD, Rich KL, Modi AC, Hooper DK, Eckman MH. A Cost-effectiveness Analysis of Adherence Promotion Strategies to Improve Rejection Rates in Adolescent Kidney Transplant Recipients. Am J Kidney Dis 2022; 80:330-340. [PMID: 35227823 PMCID: PMC9398956 DOI: 10.1053/j.ajkd.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 12/16/2021] [Indexed: 01/27/2023]
Abstract
RATIONALE & OBJECTIVE Nonadherence to medical regimens increases the risk of graft loss among adolescent and young adult recipients of kidney transplants. Interventions that improve adherence may decrease rejection rates, but their perceived costs are a barrier to clinical implementation. We developed a model to assess the cost-effectiveness of an adherence promotion strategy, the Medication Adherence Promotion System (MAPS). STUDY DESIGN Simulation-based. Data sources included published articles indexed in Medline or referenced in bibliographies of relevant English-language articles. Data on costs and outcomes were taken from a single clinical center. SETTING & POPULATION US adolescent patients after their first kidney transplant. INTERVENTION Usual posttransplant care versus usual care plus MAPS. OUTCOME Effectiveness measured in quality-adjusted life years (QALYs) and costs measured in 2020 US dollars. MODEL, PERSPECTIVE, & TIMEFRAME Markov state transition decision model. We used a health care system perspective with a lifelong time horizon. RESULTS In the base-case analysis, MAPS was more effective and less costly than usual care. MAPS cost $9,106 per patient less than usual care and resulted in a gain of 0.32 QALYs. In probabilistic sensitivity analyses, MAPS was cost saving 100% of the time. Extending results to a program level with 100 patients, any adherence promotion intervention similar in effectiveness to MAPS would cost less than $50,000/QALY if the start-up costs were <$2.5 million and annual costs <$188,000. Strategies with costs similar to MAPS that reduce the risk of rejection by as little as 3% would also have similar cost-effectiveness. LIMITATIONS Estimates of components and costs for MAPS were based on a single center. CONCLUSIONS Adherence promotion strategies with costs similar to MAPS can be cost-effective as long as they reduce rejection rates by at least 3%. This model can be applied to study the cost-effectiveness of adherence promotion strategies with varying costs and outcomes.
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Affiliation(s)
- Charles D Varnell
- Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
| | - Kristin L Rich
- Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Avani C Modi
- Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - David K Hooper
- Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Mark H Eckman
- Division of General Internal Medicine and the Center for Clinical Effectiveness, University of Cincinnati, Cincinnati, Ohio.
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8
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Zhu X, Peng B, Yi Q, Liu J, Yan J. Prediction Model of Immunosuppressive Medication Non-adherence for Renal Transplant Patients Based on Machine Learning Technology. Front Med (Lausanne) 2022; 9:796424. [PMID: 35252242 PMCID: PMC8895304 DOI: 10.3389/fmed.2022.796424] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/27/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives Predicting adherence to immunosuppressive medication (IM) is important to improve and design future prospective, personalized interventions in Chinese renal transplant patients (RTPs). Methods A retrospective, multicenter, cross-sectional study was performed in 1,191 RTPs from October 2020 to February 2021 in China. The BAASIS was used as the standard to determine the adherence of the patients. Variables of the combined theory, including the general data, the HBM, the TPB, the BMQ, the PSSS and the GSES, were used to build the models. The machine learning (ML) models included LR, RF, MLP, SVM, and XG Boost. The SHAP method was used to evaluate the contribution of predictors to predicting the risk of IM non-adherence in RTPs. Results The IM non-adherence rate in the derivation cohort was 38.5%. Ten predictors were screened to build the model based on the database. The SVM model performed better among the five models, with sensitivity of 0.59, specificity of 0.73, and average AUC of 0.75. The SHAP analysis showed that age, marital status, HBM-perceived barriers, use pill box after transplantation, and PSSS-family support were the most important predictors in the prediction model. All of the models had good performance validated by external data. Conclusions The IM non-adherence rate of RTPs was high, and it is important to improve IM adherence. The model developed by ML technology could identify high-risk patients and provide a basis for the development of relevant improvement measures.
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Affiliation(s)
- Xiao Zhu
- Nursing Department of Third Xiangya Hospital of Central South University, Changsha, China
- Research Center of Chinese Health Ministry on Transplantation Medicine Engineering and Technology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Bo Peng
- Research Center of Chinese Health Ministry on Transplantation Medicine Engineering and Technology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - QiFeng Yi
- Nursing School of Central South University, Changsha, China
- Nursing Department of Third Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: QiFeng Yi
| | - Jia Liu
- Nursing School of Central South University, Changsha, China
- Nursing Department of Third Xiangya Hospital of Central South University, Changsha, China
- Research Center of Chinese Health Ministry on Transplantation Medicine Engineering and Technology, The Third Xiangya Hospital, Central South University, Changsha, China
- Jia Liu
| | - Jin Yan
- Nursing School of Central South University, Changsha, China
- Nursing Department of Third Xiangya Hospital of Central South University, Changsha, China
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9
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Dziarmaga R, Ke D, Sapir-Pichhadze R, Cardinal H, Phan V, Piccirillo CA, Mazer B, Foster BJ. Age- and sex-mediated differences in T lymphocyte populations of kidney transplant recipients. Pediatr Transplant 2022; 26:e14150. [PMID: 34569133 DOI: 10.1111/petr.14150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Graft failure rates increase through childhood and adolescence, decline in adulthood, and are higher in female than male kidney transplant recipients (KTR) until middle age. We aimed to describe age- and sex-related differences in T-cell subsets among KTR to determine which differences may help to explain the differences in kidney graft failure rates. METHODS Effector T (Teff)-cell and regulatory T (Treg)-cell phenotypes in PBMCs from healthy controls and KTR, who were at least 1 year post-transplant with stable graft function under immunosuppression, were analyzed by flow cytometry. The effects of age, sex, and status (KTR or control) were analyzed using linear regressions. RESULTS We enrolled 20 male and 21 female KTR and 20 male and 20 female controls between 3 and 29 years of age. CD3+ T-cell frequencies were not associated with age or sex but were higher in KTR than controls. There were no differences in CD4+ and CD8+ frequencies. Th1 (IFNγ+ IL-4- IL-17A-) and Th17 (IL-17A+) frequencies within the CD4+ T-cell population were higher at older ages. The frequencies of FOXP3 + Helios + Treg cells in CD4+ CD25+ CD127- T cells were lower in females than males and in KTR than controls. CONCLUSIONS Increasing frequencies of Th1 and Th17 cells with increasing age mirrors the increasing graft failure rates from childhood to young adulthood. Importantly, sex differences in frequencies of circulating Treg cells may suggest a role in the sex differences in graft failure rates.
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Affiliation(s)
- Robert Dziarmaga
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Danbing Ke
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Ruth Sapir-Pichhadze
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Division of Nephrology and Multi-Organ Transplant Program, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Héloïse Cardinal
- Département de Médecine, Université de Montréal, Montreal, Quebec, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Véronique Phan
- Département de Pédiatrie, Université de Montréal, Montreal, Quebec, Canada.,Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Ciriaco A Piccirillo
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
| | - Bruce Mazer
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada.,Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Bethany J Foster
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Department of Pediatrics, McGill University, Montreal, Quebec, Canada
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10
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Foster BJ, Zhang X, De Simone A, Dahhou M, Sapir-Pichhadze R, Cardinal H, West L. Differences in Heart Graft Survival by Recipient Sex. Transplant Direct 2021; 7:e749. [PMID: 34514105 DOI: 10.1097/TXD.0000000000001110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 11/08/2020] [Indexed: 11/27/2022] Open
Abstract
Supplemental Digital Content is available in the text. We aimed to characterize patterns of differences in heart graft failure rates by recipient sex, accounting for modifying effects of donor sex and recipient age.
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11
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Marsicano-Souza EO, Colugnati F, Geest SD, Sanders-Pinheiro H. Nonadherence to immunosuppressives and treatment in kidney transplant: ADHERE BRAZIL Study. Rev Saude Publica 2021; 55:33. [PMID: 34076208 PMCID: PMC8139843 DOI: 10.11606/s1518-8787.2021055002894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/25/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate the prevalence and variability of nonadherence to immunosuppressives and nonpharmacological treatment across kidney transplantation centers and two health access-disparate regions in Brazil. METHODS In a cross-sectional design, a random multistage sample of 1,105 patients was included, based on center transplantation activity (low/moderate/high) and region (R1: North/Northeast/Mid-West; and R2: South/Southeast). Nonadherence to immunosuppressives (implementation phase) was assessed using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS)©. Self-report questionnaires assessed nonadherence to physical activity, smoking cessation, alcohol intake, and appointment keeping. We compared regions using the adjusted-χ2 or t-test. RESULTS Most patients were men (58.5%), white (51.4%), and had a mean age of 47.5 (SD = 12.6) years. Regarding kidney transplantation centers, 75.9% were from R2 and 38.2% had low activity. The patients in R2 were older, white-majority, had more frequently steady partners, and received peritoneal dialysis. Nonadherence to immunosuppressives ranged from 11–65.2%; 44.5–90% to physical activity; 0–23.7% to appointment keeping; and 0–14% to smoking cessation. The total prevalence of nonadherence and by region (R1 versus R2) were: for immunosuppressives, 39.7% (44.9% versus 38.1%, p = 0.18); for smoking, 3.9% (1% versus 5%, p < 0.001); for physical activity, 69.1% (71% versus 69%, p = 0.48); for appointment keeping, 13% (12.7% versus 12%, p = 0.77); and for alcohol consumption, 0%. CONCLUSION Despite differences among centers and high variability, only the nonadherence to smoking cessation was higher in the region with greater access to kidney transplantation. We suppose that differences in healthcare access may have been overcome by other positive aspects of the post kidney transplantation treatment.
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Affiliation(s)
- Elisa Oliveira Marsicano-Souza
- Universidade Federal de Juiz de Fora. Hospital Universitário. Unidade de Transplante Renal. Juiz de Fora, MG, Brasil.,Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN). Juiz de Fora, MG, Brasil
| | - Fernando Colugnati
- Universidade Federal de Juiz de Fora. Hospital Universitário. Unidade de Transplante Renal. Juiz de Fora, MG, Brasil.,Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN). Juiz de Fora, MG, Brasil
| | - Sabina De Geest
- University of Basel. Institute of Nursing Science. Department of Public Health. Basel, Switzerland.,KU Leuven. Academic Centre for Nursing and Midwifery. Department of Public Health and Primary Care. Leuven, Belgium
| | - Helady Sanders-Pinheiro
- Universidade Federal de Juiz de Fora. Hospital Universitário. Unidade de Transplante Renal. Juiz de Fora, MG, Brasil.,Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN). Juiz de Fora, MG, Brasil
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12
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Zhang P, Zhu X, Yan J, Liu J. Identification of Immunosuppressive Medication Nonadherence Factors Through a Combined Theory Model in Renal Transplant Recipients: 6-12. Front Pharmacol 2021; 12:655836. [PMID: 34122077 PMCID: PMC8187913 DOI: 10.3389/fphar.2021.655836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/07/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Immunosuppressive medication (IM) nonadherence is associated with poor transplant outcomes. Therefore, it is of great importance to identify predictive factors with IM nonadherence. We aimed to improve the predicted capacity of the theory of planned behavior (TPB) by adding health belief model's (HBM) variables in renal transplant patients (RTPs). Methods: This cross-sectional study distributed questionnaires to patients who had undergone renal transplant and follow-up regularly in the transplant center of Third Xiangya Hospital in China. The self-developed questionnaire collected data in three aspects: general data questionnaire, TPB, HBM-specific questionnaire, and Basel Assessment of Adherence to Immunosuppressive Medications scale. Results: A total of 1,357 of 1,480 patients completed the survey, with a participation rate of 91.69% and IM nonadherence rate of 33.53%. The marital status, household income, preoperative drinking history, the time after transplantation, and religion showed independent predictive factors with IM nonadherence (p < 0.05). Strikingly, adding HBM variables to the TPB theory model significantly increased its prediction ability to IM nonadherence (52%). Also, HBM manifested the highest coefficient of effect (-0.620). Particularly, perceived barriers and perceived seriousness, the variables of the HBM model, played a vital influence on medication nonadherence (-0.284 and 0.256). Conclusion: Our study here reveals the first investigation of the combined effects of the TPB and HBM model on IM nonadherence in Chinese RTPs, which could significantly improve the predictive ability of any single model. Meanwhile, future interventions should be conducted to both increase perceived seriousness and reduce perceived barriers for taking IM, which will effectively decrease IM nonadherence rates and improve transplant outcomes.
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Affiliation(s)
- Pengpeng Zhang
- Department of Transplantation, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiao Zhu
- Department of Transplantation, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jin Yan
- The Nursing Department, the Third Xiangya Hospital of Central South University, Changsha, China
| | - Jia Liu
- Department of Transplantation, The Third Xiangya Hospital of Central South University, Changsha, China.,The Nursing School of Central South University, Changsha, China
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13
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Pollack AH, Snyder J. Reflecting on patient-generated photographs of the pediatric renal transplant experience. Pediatr Transplant 2021; 25:e13896. [PMID: 33111458 PMCID: PMC8108545 DOI: 10.1111/petr.13896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/15/2020] [Accepted: 10/01/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Poor self-management contributes to reduced renal allograft survival during adolescence and young adulthood. Providing patients with self-reflection tools to help explore the question "Is my experience normal?" may help mitigate these challenges. We explore Photograph-elicitation, a qualitative method where images are used to prompt individuals to talk about their personal experiences and values, engages pediatric transplant recipients and their families to generate insight into their experiences and the challenges they face after transplant. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS Pediatric renal transplant recipients and one family member from Seattle Children's Hospital submitted 5 photographs showcasing their transplant story, which were used as prompts during semi-structured interviews. Interviews were recorded, transcribed, and analyzed using thematic analysis. RESULTS Twenty-four individuals (13 patients: ages 7-21, and 11 parents) completed the study. Conversations generated by the photographs covered topics in more depth than a routine clinical encounter leading to more opportunities for reflection by patients and their family. The photographs generated conversations on four emergent themes: (a) sensemaking; (b) transitions and agency; (c) social interactions and community engagement; and (d) barriers and obstacles. CONCLUSIONS Photograph elicitation generated a rich dataset describing a range of pediatric renal transplant experiences helping physicians gain a rich and nuanced understanding of the daily lives and experiences of their patients outside the clinical setting. Photograph elicitation, as a clinical intervention, may provide new opportunities to address previously unrecognized modifiable risk factors, improving graft survival and health-related quality of life.
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Affiliation(s)
- Ari H. Pollack
- Seattle Children’s Hospital, Seattle, WA, USA,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Jaime Snyder
- Information School, University of Washington, Seattle, WA, USA
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14
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Eslami S, Khoshrounejad F, Golmakani R, Taherzadeh Z, Tohidinezhad F, Mostafavi SM, Ganjali R. Effectiveness of IT-based interventions on self-management in adult kidney transplant recipients: a systematic review. BMC Med Inform Decis Mak 2021; 21:2. [PMID: 33388049 PMCID: PMC7778800 DOI: 10.1186/s12911-020-01360-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/02/2020] [Indexed: 11/23/2022] Open
Abstract
Background Kidney transplant outcomes are broadly associated with transplant recipients’ capacity in following a complex and continuous self-management regimen. Health information technology has the potential to empower patients. This systematic review aimed to determine the impacts of IT-based interventions for self-management in kidney transplant recipients.
Methods A comprehensive investigation was performed in MEDLINE (via PubMed) and EMBASE (via Scopus) in April 2019. Eligible studies were the randomized controlled trials which aimed to design an automated IT-based intervention. All English papers including adult kidney transplant recipients were included. To assess the clinical trial’s quality, Cochrane Collaboration’s assessment tool was employed. The articles were integrated based on category of outcomes, characteristics of interventions, and their impact. The interventions were classified based on the used IT-based tools, including smart phones, coverage tools, computer systems, and a combination of several tools. The impact of interventions was defined as: (1) positive effect (i.e. statistically significant), and (2) no effect (i.e. not statistically significant). Results A total of 2392 articles were retrieved and eight publications were included for full-text analysis. Interventions include those involving the use of computerized systems (3 studies), smart phone application (3 studies), and multiple components (2 studies). The studies evaluated 30 outcomes in total, including 24 care process and 6 clinical outcomes. In 18 (80%) out of 30 outcomes, interventions had a statistically significant positive effect, 66% in process and 33% in clinical outcomes. Conclusions IT-based interventions (e.g. mobile health applications, wearable devices, and computer systems) can improve self-management in kidney transplant recipients (including clinical and care process outcomes). However, further evaluation studies are required to quantify the impact of IT-based self-management interventions on short- and long-term clinical outcomes as well as health care costs and patients' quality of life.
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Affiliation(s)
- Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Azadi Street, Mashhad, Iran.,Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farnaz Khoshrounejad
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Azadi Street, Mashhad, Iran
| | - Reza Golmakani
- Department of Emergency Medicine, Doctor Shariati Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zhila Taherzadeh
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fariba Tohidinezhad
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Azadi Street, Mashhad, Iran
| | - Sayyed Mostafa Mostafavi
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Azadi Street, Mashhad, Iran
| | - Raheleh Ganjali
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Azadi Street, Mashhad, Iran.
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15
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Sanders-Pinheiro H, Colugnati FAB, Denhaerynck K, Marsicano EO, Medina JOP, De Geest S. Multilevel Correlates of Immunosuppressive Nonadherence in Kidney Transplant Patients: The Multicenter ADHERE BRAZIL Study. Transplantation 2021; 105:255-266. [PMID: 32150041 DOI: 10.1097/tp.0000000000003214] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Immunosuppressive nonadherence is a risk factor for worse outcomes after kidney transplantation (KT). Brazil, having the world's largest public, fully covered transplantation system and the second-highest KT volume worldwide, provides a unique setting for studying multilevel correlates of nonadherence (patient, healthcare provider, transplant center, and healthcare system levels) independent of patients' financial burden. METHODS By applying a multistage sampling approach, we included 1105 patients from 20 KT centers. Nonadherence to immunosuppressives (implementation phase) was defined as any deviation in taking or timing adherence and dose reduction assessed by the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Based on Bronfenbrenner's ecological model, we assessed multilevel factors using established instruments and measures specifically developed for this study and analyzed their independent contribution to nonadherence by performing sequential logistic regression analysis. RESULTS The nonadherence prevalence rate was 39.7%. The following factors were independently associated with nonadherence: Patient level-having a stable partner (odds ratio [OR]: 0.75; confidence interval [CI]: 0.58-0.97), nonadherence to appointments (OR: 2.98; CI: 2.03-4.39), and nonadherence to physical activity recommendations (OR: 1.84; CI: 1.38-2.46); and transplant center level-satisfaction with the waiting room structure (OR: 0.54; CI: 0.42-0.71), consultation >30 minutes (OR: 1.60; CI: 1.19-2.14), adequacy of the consultation frequency (OR: 0.62; CI: 0.43-0.90), and centers with >500 beds (OR: 0.58; CI: 0.46-0.73). CONCLUSIONS As the first multicenter study assessing multilevel correlates of nonadherence in KT, our findings point to the need for multilevel interventions beyond the patient level, targeting transplant center practice patterns as an approach to tackle nonadherence.
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Affiliation(s)
- Helady Sanders-Pinheiro
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Minas Gerais, Brazil and Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
| | - Fernando A B Colugnati
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Minas Gerais, Brazil and Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
| | - Kris Denhaerynck
- Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Elisa O Marsicano
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Minas Gerais, Brazil and Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
| | - José O P Medina
- Hospital do Rim e Hipertensão, Oswaldo Ramos Foundation, Nephrology Discipline, Federal University of São Paulo, São Paulo, Brazil
| | - Sabina De Geest
- Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
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16
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De Simone AI, Zhang X, Dahhou M, Sapir-Pichhadze R, Cardinal H, Ng V, Foster BJ. Differences in Liver Graft Survival by Recipient Sex. Transplant Direct 2020; 6:e629. [PMID: 33204827 DOI: 10.1097/TXD.0000000000001084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/26/2020] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. We aimed to characterize patterns of differences in liver graft failure rates by recipient sex, accounting for the modifying effects of donor sex and recipient age.
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17
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Park S, Kim M, Kim JE, Kim K, Park M, Kim YC, Joo KW, Kim YS, Lee H. Characteristics of kidney transplantation recipients over time in South Korea. Korean J Intern Med 2020; 35:1457-1467. [PMID: 32218102 PMCID: PMC7652657 DOI: 10.3904/kjim.2019.292] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 10/27/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND/AIMS Detailed nationwide information regarding the recent status and time trends of kidney transplantation (KT) in South Korea is limited. METHODS We performed a nationwide, population-based cohort study using the national claims database of Korea. We included KT recipients from 2008 to 2016, and their demographic and clinical characteristics were collected. The prognostic outcome was graft failure consisted of patient death and death-censored graft failure (DCGF). RESULTS We studied 14,601 KT recipients with median follow-up duration of 3.96 years. The median age at the time of transplantation consistently increased from the past, and proportion of underlying diabetes mellitus prominently increased, reaching 35.6% in 2016. The preemptive KT accounted for approximately 30% of the total transplantation cases. The recipients showed a 10-year cumulative graft survival rate of 71.8%, consisting of 10-year DCGF free survival of 77.6% and patient survival of 92.8%. Age ≥ 20 and < 30 years, age ≥ 70 years, underlying history of diabetes, non-preemptive transplantation, and poor compliance on tacrolimus and mycophenolic acid were the significant risk factors associated with worse DCGF outcome. The economic cost of KT showed prominently increasing trends, reaching a total insured fee of > 60,000,000$ in 2016. However, the expansion was mainly burdened by the national insurance service but not by the patients. CONCLUSION In South Korea, the number of kidney transplantation in elderly or in patients with comorbidities has been increasing. Complex clinical factors were associated with medication compliance and patient prognosis.
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Affiliation(s)
- Sehoon Park
- Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Myoungsuk Kim
- Department of Biomedical Research, Seoul National University Hospital, Seoul, Korea
| | - Ji Eun Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kwangsoo Kim
- Department of Biomedical Research, Seoul National University Hospital, Seoul, Korea
| | - Minsu Park
- Statistics and Data Center, Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yon Su Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Correspondence to Hajeong Lee, M.D. Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-4905 Fax: +82-2-766-9662 E-mail:
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18
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Belaiche S, Décaudin B, Caron A, Depas N, Vignaux C, Vigouroux S, Coiteux V, Magro L, Sirvent A, Huynh A, Turlure P, Farge D, Lioure B, Bruno B, De Berranger E, Maillard N, Bourhis JH, Bay JO, Bulabois CE, Ceballos P, Fegueux N, Hicheri Y, Vincent L, Rialland F, Gandemer V, Taque S, Cornillon J, Contentin N, Galambrun C, Plantaz D, Odou P, Yakoub-Agha I. Medication non-adherence after allogeneic hematopoietic cell transplantation in adult and pediatric recipients: a cross sectional study conducted by the Francophone Society of Bone Marrow Transplantation and Cellular Therapy. Fundam Clin Pharmacol 2020; 35:435-445. [PMID: 32740936 DOI: 10.1111/fcp.12593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 06/09/2020] [Accepted: 07/27/2020] [Indexed: 12/14/2022]
Abstract
Medication non-adherence (NA) after allogeneic hematopoietic cell transplantation (allo-HCT) can lead to serious complications. This study assesses NA in French adult and pediatric recipients and identifies factors associated with NA. In accordance with the EMERGE and STROBE guidelines, a cross sectional multicentric survey was conducted. We used a self-reported questionnaire that was adapted to adults and pediatrics and that could provide a picture of all three phases of medication adherence: initiation, implementation, persistence. We enrolled 242 patients, 203 adults (mean age: 51 years old, 50.7% male) and 39 children (mean age: 9 years old, 56.4% female). Reported NA was estimated at about 75% in both populations, adults and pediatrics. In adults, the univariate analysis showed that patients less than 50 years old (P = 0.041), (i) treated with cyclosporine (P = 0.02), (ii) treated with valacyclovir/acyclovir (P = 0.016), and (iii) experiencing side effects (P = 0.009), were significantly more non-adherent. In multivariate analysis, only recipient age was significantly associated to NA (P = 0.05). The limited size of the pediatric population did not allow us to draw any statistical conclusion about this population. To the best of our knowledge, this is the first study in France on NA in allo-HCT recipients. Our results highlight the age factor as the only factor related to NA. Further studies are needed to confirm our observations and refine results in pediatric populations, currently most at risk of medication NA.
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Affiliation(s)
| | | | - Alexandre Caron
- EA 2694 - Santé publique: épidémiologie et qualité des soins, CHU Lille, Univ. Lille, Lille, F-59000, France
| | - Nicolas Depas
- EA 2694 - Santé publique: épidémiologie et qualité des soins, CHU Lille, Univ. Lille, Lille, F-59000, France
| | - Claire Vignaux
- Service Hématologie Adulte, CHU Bordeaux, Bordeaux Cedex, F-33076, France
| | - Stephane Vigouroux
- Service Hématologie Adulte, CHU Bordeaux, Bordeaux Cedex, F-33076, France
| | | | | | - Anne Sirvent
- Service Hématologie Pédiatrique, CHU Montpellier, Montpellier, F-34090, France
| | - Anne Huynh
- Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse Cedex 9, F-31059, France
| | - Pascal Turlure
- Service Hématologie Adulte, CHU Dupuytren, Limoges Cedex, F-87042, France
| | - Dominique Farge
- Service Hématologie Adulte, APHP- Hopital Saint Louis, Paris, F-75010, France
| | - Bruno Lioure
- Service Hématologie Adulte, Hopital de Hautepierre, CHU de Strasbourg, Strasbourg, F-67200, France
| | - Bénédicte Bruno
- Service Hématologie Pédiatrique, CHU Lille, Lille, F-59000, France
| | - Eva De Berranger
- Service Hématologie Pédiatrique, CHU Lille, Lille, F-59000, France
| | - Natacha Maillard
- Service Hématologie Adulte, CHU Poitier, Poitier, F-86000, France
| | - Jean-Henri Bourhis
- Service Hématologie Adulte, Institut Gustave Roussy, Villejuif Cedex, F-94805, France
| | | | | | - Patrice Ceballos
- Service Hématologie Adulte, CHU Montpellier, Montpellier, F-34090, France
| | - Nathalie Fegueux
- Service Hématologie Adulte, CHU Montpellier, Montpellier, F-34090, France
| | - Yosr Hicheri
- Service Hématologie Adulte, CHU Montpellier, Montpellier, F-34090, France
| | - Laure Vincent
- Service Hématologie Adulte, CHU Montpellier, Montpellier, F-34090, France
| | - Fanny Rialland
- Service Hématologie Pédiatrique, CHU Nantes, Nantes, F-44000, France
| | - Virginie Gandemer
- Service Hématologie Pédiatrique, CHU Rennes, Rennes Cedex 9, F-35033, France
| | - Sophie Taque
- Service Hématologie Pédiatrique, CHU Rennes, Rennes Cedex 9, F-35033, France
| | - Jérôme Cornillon
- Service Hématologie Adulte, Institut de Cancérologie Lucien Neuwirth, Saint Etienne, F-42000, France
| | - Nathalie Contentin
- Service Hématologie Adulte, Centre Henri Becquerel, Rouen Cedex, F 76038, France
| | - Claire Galambrun
- Service Hématologie Pédiatrique, APHM Hopital La Timone, Marseille, F-13005, France
| | - Dominique Plantaz
- Service Hématologie Pédiatrique, CHU Grenoble, La Tronche, F-38700, France
| | - Pascal Odou
- Institut de Pharmacie, CHU Lille, Lille, F-59000, France
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19
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Melk A, Babitsch B, Borchert-Mörlins B, Claas F, Dipchand AI, Eifert S, Eiz-Vesper B, Epping J, Falk CS, Foster B, Geyer S, Gjertson D, Greer M, Haubitz M, Lau A, Maecker-Kolhoff B, Memaran N, Messner HA, Ostendorf K, Samuel U, Schmidt BMW, Tullius SG, West L, Wong G, Zimmermann T, Berenguer M. Equally Interchangeable? How Sex and Gender Affect Transplantation. Transplantation 2019; 103:1094-110. [PMID: 30747857 DOI: 10.1097/TP.0000000000002655] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Organ transplantation as an option to overcome end-stage diseases is common in countries with advanced healthcare systems and is increasingly provided in emerging and developing countries. A review of the literature points to sex- and gender-based inequity in the field with differences reported at each step of the transplant process, including access to a transplantation waiting list, access to transplantation once waitlisted, as well as outcome after transplantation. In this review, we summarize the data regarding sex- and gender-based disparity in adult and pediatric kidney, liver, lung, heart, and hematopoietic stem cell transplantation and argue that there are not only biological but also psychological and socioeconomic issues that contribute to disparity in the outcome, as well as an inequitable access to transplantation for women and girls. Because the demand for organs has always exceeded the supply, the transplant community has long recognized the need to ensure equity and efficiency of the organ allocation system. In the spirit of equity and equality, the authors call for recognition of these inequities and the development of policies that have the potential to ensure that girls and women have equitable access to transplantation.
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20
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Chisholm-Burns MA, Spivey CA, Potukuchi PK, Streja E, Kalantar-Zadeh K, Kovesdy CP, Molnar MZ. Association between Posttransplant Opioid Use and Immunosuppressant Therapy Adherence among Renal Transplant Recipients. Nephron Clin Pract 2020; 144:321-330. [PMID: 32434210 DOI: 10.1159/000507257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 03/14/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Little is known about the effect of posttransplant opioid use on adherence to immunosuppressant therapy (IST) among adult renal transplant recipients (RTRs). OBJECTIVE The aim of this study was to examine the relationship between opioid use and IST adherence among adult RTRs during the first year posttransplant. METHODS Longitudinal data were analyzed from a retrospective cohort study examining US veterans undergoing renal transplant from October 1, 2007, through March 31, 2015. Data were collected from the US Renal Data System, Centers for Medicare and Medicaid Services Data (Medicare Part D), and Veterans Affairs pharmacy records. Dose of opioid prescriptions was collected and divided based on annual morphine milligram equivalent within a year of transplant. Proportion of days covered of greater than or equal to 80% indicated adherence to tacrolimus. Unadjusted and multivariable-adjusted logistic regression analyses were performed. RESULTS A study population of 1,229 RTRs included 258 with no opioid use, while 971 opioid users were identified within the first year after transplantation. Compared to RTRs without opioid usage, RTRs with opioid usage had a lower probability of being adherent to tacrolimus in unadjusted logistic regression (odds ratio [OR] (95% confidence interval [CI]): 0.22 [0.07-0.72]) and adjusted logistic regression (OR [95% CI]: 0.11 [0.03-0.44]). These patterns generally remained consistent in unadjusted and adjusted main and sensitivity analyses. CONCLUSIONS Findings indicate RTRs who use prescription opioids during the first year posttransplant, regardless of the dosage/amount, are less likely to be adherent to tacrolimus. Future studies are needed to better understand underlying causes of the association between opioid use and tacrolimus nonadherence.
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Affiliation(s)
- Marie A Chisholm-Burns
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee, USA,
| | - Christina A Spivey
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Praveen K Potukuchi
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Institute for Health Outcomes and Policy, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Elani Streja
- Division of Nephrology, University of California, Irvine, California, USA
| | | | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee, USA
| | - Miklos Z Molnar
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Methodist University Hospital Transplant Institute, Memphis, Tennessee, USA.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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21
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Abstract
PURPOSE OF REVIEW Despite evidence of gender-specific differences in epidemiology and outcomes in all stages of chronic kidney disease (CKD), most studies ignore the issue of gender. This review addresses this knowledge gap by evaluating data on gender disparity in this population. RECENT FINDINGS Population-based studies indicate a higher prevalence of CKD in women; however, there are fewer women on renal replacement therapy than men. Men may progress to end-stage kidney disease more rapidly. Gender differences in rates of CKD progression may be influenced by potential antifibrotic and antiapoptotic effects of estrogen or proinflammatory deleterious effects of testosterone. Women are referred later for kidney replacement therapy and receive fewer arteriovenous fistulas than men receive, irrespective of race. Women are also less likely to receive kidney transplants as compared with men but are more likely to donate a kidney. SUMMARY Recommendations for medical management of CKD patients are currently made in a gender-blind manner, despite the fact that women have differing underlying physiology. Addressing gender differences and disparities is an important and overlooked area in the care of patients with kidney disease.
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22
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Maldonado AQ, Hall RC, Pilch NA, Ensor CR, Anders S, Gilarde JA, Tichy EM. ASHP Guidelines on Pharmacy Services in Solid Organ Transplantation. Am J Health Syst Pharm 2019; 77:222-232. [DOI: 10.1093/ajhp/zxz291] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
| | - Reed C Hall
- University Health System, San Antonio, TX
- Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX
| | | | | | - Stephanie Anders
- Transplant Pharmacy Services, Ochsner Clinic Foundation, New Orleans, LA
| | | | - Eric M Tichy
- Supply Chain Management, Mayo Clinic, Rochester, MN
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23
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Gokoel SRM, Gombert-Handoko KB, Zwart TC, van der Boog PJM, Moes DJAR, de Fijter JW. Medication non-adherence after kidney transplantation: A critical appraisal and systematic review. Transplant Rev (Orlando) 2019; 34:100511. [PMID: 31627978 DOI: 10.1016/j.trre.2019.100511] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 10/26/2022]
Abstract
Medication non-adherence is one of the most important causes for shortened graft survival subsequently leading to a reduction in kidney graft survival results. Our aim was to provide an overview of its prevalence, risk factors, diagnostic methods and interventions to improve adherence in kidney transplant recipients. Therefore, we systematically searched the databases PubMed, COCHRANE Library, Web of Science and EMBASE for studies addressing "medication adherence", "compliance", "adherence", "kidney transplantation" and "life style factors". We identified 96 studies that satisfied our inclusion criteria. A problematic lack of a uniformly accepted definition for non-adherence was found, consequently leading to a wide range in non-adherence prevalence (36-55%). Using one uniformly accepted non-adherence definition should therefore be encouraged. A wide range in diagnostic methods makes it difficult to accurately detect non-adherence. Heterogeneous results of intervention studies make it difficult to select the best adherence enhancing method, challenging the battle against medication non-adherence. Literature suggests a combination of personalized interventions, based on patient-specific non-adherent behavior, to be most successful in improvement of adherence. High quality diagnostic methods and multidisciplinary, personalized interventions with focus on relevant clinical outcome are essential in overcoming medication non-adherence in kidney transplant recipients.
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Affiliation(s)
- Sumit R M Gokoel
- Division of Nephrology, Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands.
| | - Kim B Gombert-Handoko
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tom C Zwart
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Paul J M van der Boog
- Division of Nephrology, Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Dirk Jan A R Moes
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Johan W de Fijter
- Division of Nephrology, Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
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24
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Boucquemont J, Pai ALH, Dharnidharka VR, Hebert D, Furth SL, Foster BJ. Gender Differences in Medication Adherence Among Adolescent and Young Adult Kidney Transplant Recipients. Transplantation 2019; 103:798-806. [PMID: 29994983 DOI: 10.1097/TP.0000000000002359] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Among kidney transplant recipients, gender differences in medication adherence may contribute to higher graft failure risks observed in girls and young women compared with boys and young men. Our aim was to determine whether adherence differs by gender, and whether gender differences vary by age in adolescent and young adult kidney transplant recipients. METHODS We examined data from the 3-month run-in period (no intervention) of the randomized Teen Adherence in Kidney transplant Effectiveness of Intervention trial. Adherence was monitored using electronic pillboxes in 136 patients (11-24 y) followed in 8 transplant centers in Canada and the United States. We used ordinal logistic regression with generalized estimating equations to estimate the association between gender and each of daily taking (proportion of prescribed doses taken) and timing (proportion of prescribed doses taken on time) adherence, considering effect modification by age (11-16 y vs 17-24 y). RESULTS No difference in taking adherence was observed by gender among participants aged 11 to 16 years (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.55-1.54), whereas among participants aged 17 to 24 years, women had significantly greater odds of higher taking adherence scores (OR, 3.03; 95% CI, 1.20-7.66) than men. Results were similar for timing adherence, with no difference among participants aged 11 to 16 years (OR, 1.03; 95% CI, 0.65-1.63) but a greater odds of higher timing adherence scores in women than in men among participants aged 17 to 24 years (OR, 3.26; 95% CI, 1.43-7.45). There were no differences in adherence assessed by self-report or SD of tacrolimus trough levels. CONCLUSIONS Gender differences in adherence vary by age. Whereas younger adolescents show no adherence differences by gender, young women show much better adherence than young men.
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25
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Kobayashi S, Tsutsui J, Okabe S, Hideki I, Akaho R, Nishimura K. Medication nonadherence after kidney transplantation: an internet-based survey in Japan. PSYCHOL HEALTH MED 2019; 25:91-101. [PMID: 31144516 DOI: 10.1080/13548506.2019.1622745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Nonadherence to immunosuppressive medications after kidney transplantation is a major risk factor for allograft rejection and graft loss. Transplant recipients tend to conceal nonadherence in clinical settings. We conducted an internet-based cross-sectional survey aimed to clarify the prevalence and risk factors of patient nonadherence after kidney transplantation in Japan. The Basel Assessment of Adherence to Immunosuppressive Medication Scale (BAASIS©) was used to detect nonadherence. In this survey, patients were asked about their relationship with medical staff and their self-efficacy for taking medication, along with other questions. A total of 219 kidney transplant recipients were included in the analysis. Ninety-four demonstrated nonadherence (42.7%). The following factors were associated with nonadherence: short dialysis period prior to transplantation; undergoing transplantation at least twice; male sex; lack of satisfaction with the explanation of immunosuppressive medication; and absence of medical staff to consult upon forgetting to take drugs. The nonadherence group reported low self-efficacy for medication in many settings. This anonymous survey provides valuable insight into the actual nonadherence rate, factors associated with nonadherence, and life situations that may complicate medication-taking.
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Affiliation(s)
- Sayaka Kobayashi
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.,Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Junko Tsutsui
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Sachi Okabe
- Department of Nursing, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Ishida Hideki
- Department of Urology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Rie Akaho
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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26
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Low JK, Manias E, Crawford K, Walker R, Mulley WR, Toussaint ND, Dooley M, Kennedy E, Smith CL, Nalder M, Yip D, Williams A. Improving medication adherence in adult kidney transplantation (IMAKT): A pilot randomised controlled trial. Sci Rep 2019; 9:7734. [PMID: 31118485 PMCID: PMC6531445 DOI: 10.1038/s41598-019-44002-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 05/02/2019] [Indexed: 11/09/2022] Open
Abstract
Resources to support long-term medication adherence in kidney transplantation are limited. This study aimed to determine the efficacy of an intervention designed for kidney transplant recipients to enhance medication adherence. A single-blind, multi-site, 12-month pilot randomised controlled trial was conducted at all five public hospitals providing adult kidney transplantation in Victoria, Australia. Participants were recruited at 4 to 6 weeks post-transplantation. Thirty-five participants were randomly assigned to a 3-month intervention, involving a face-to-face meeting (a medication review and a consumer-centred video) and health coaching every two weeks. Thirty-six were randomised to receive usual care. All participants were followed for nine months post-intervention. There were no differences in adherence between groups measured by Medication Event Monitoring System (MEMS), however, it was underutilised by 42% of participants. Based on the self-reported Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS©) score, the percentage of adherent participants decreased significantly between baseline and 3 to 12 months in the control group (p-values < 0.001) whilst the percentage of adherent participants in the intervention group remained constant over time. No group differences were detected in other outcomes. Due to the complex medication regimen, developing and testing a medication adherence intervention is difficult in kidney transplantation.
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Affiliation(s)
- Jac Kee Low
- Monash Nursing & Midwifery, Monash University, Clayton, Victoria, Australia. .,School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Burwood, Victoria, Australia.
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Burwood, Victoria, Australia.,The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Kimberley Crawford
- Monash Nursing & Midwifery, Monash University, Clayton, Victoria, Australia
| | - Rowan Walker
- Department of Renal Medicine, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - William R Mulley
- Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia.,Centre for Inflammatory Diseases, Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Michael Dooley
- Alfred Health, Prahran, Victoria, Australia.,Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
| | - Elaine Kennedy
- Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia
| | - Catherine L Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michelle Nalder
- Pharmacy Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Doris Yip
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Allison Williams
- Monash Nursing & Midwifery, Monash University, Clayton, Victoria, Australia
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27
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Bakr MA, Nagib AM, Abbas MH, Donia AF. Conversion From Twice-Daily to Once-Daily Tacrolimus Among Egyptian Living-Donor Kidney Allograft Recipients: A Single-Center Experience. EXP CLIN TRANSPLANT 2019; 17:594-598. [PMID: 31050617 DOI: 10.6002/ect.2018.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Adherence to immunosuppression and minimization of drug exposure are important con-siderations in preventing rejection and maximizing transplant outcomes. The once-daily tacrolimus protocol confers potential benefit by simplifying immunosuppressive regimens, thereby improving adherence among transplant recipients. Studies of stable transplant recipients have suggested that once-daily tacrolimus is bioequivalent to twice-daily tacrolimus and is noninferior to twice-daily tacrolimus with a concentration-dependent rejection risk. Our aim was to evaluate the safety and efficacy of conversion from twice-daily tacrolimus formulation to a once-daily formulation among a cohort of adult living related-donor renal transplant patients as a single-center experience. MATERIALS AND METHODS This prospective, one arm, single-center study included 238 patients with at least 12 months posttransplant follow-up and no rejection episodes in the last 3 months. Conversion from twice-daily to once-daily formulation was based on a 1:1 ratio. RESULTS The mean tacrolimus dose was 4.7 ± 2.7 mg/day preconversion versus 4.9 ± 3.2 mg/day postconversion (P = .8). The mean tacrolimus level was 7.4 ± 3.4 versus 6.1 ± 2.8 ng/mL (P = .75). Of total patients, 45% were maintained on a tacrolimus dose of less than 2 ng/dL. Renal function was comparable before and after conversion (mean serum creatinine was 1.25 ± 0.88 vs 1.23 ± 0.78 mg/dL; P = .9). The incidence of biopsy-proven acute rejection was 19.7% preconversion versus 4.2% postconversion. Graft and patient survival rates were comparable between the 2 tacrolimus formulations. Once-daily tacrolimus also had favorable effects on blood pressure, lipid profile, and glucose tolerance. CONCLUSIONS Conversion from conventional tacrolimus (twice daily) to once-daily tacrolimus may be a valuable option with comparable patient and graft survival and may lead to improved adherence that may be reflective of better long-term results. It should be considered for de novo immunosuppression among living-donor renal allotransplant recipients.
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Affiliation(s)
- Mohamed Adel Bakr
- From the Department of Dialysis and Transplantation, The Urology-Nephrology Center, Mansoura University, Mansoura, Egypt
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28
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Tillmann FP, Quack I, Woznowski M, Rump LC. Effect of recipient-donor sex and weight mismatch on graft survival after deceased donor renal transplantation. PLoS One 2019; 14:e0214048. [PMID: 30925158 DOI: 10.1371/journal.pone.0214048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/06/2019] [Indexed: 12/05/2022] Open
Abstract
This study evaluated the combined effect of recipient-to-donor weight and sex mismatch after deceased-donor renal transplantation in a German transplant cohort and the evolution of recipient-to-donor weight difference over a 13-year observation period. The association of absolute weight and sex difference with graft failure was explored in an outpatient cohort of deceased-donor transplant recipients who underwent kidney transplantation between 2000 and 2012. Graft failure was defined as repeated need for dialysis or death with a functioning graft. Recipient and donor sex pairings were classified as sex concordant (MDMR/FDFR) or discordant (MDFR/FDMR). These classes were further stratified into four groups according to recipient-to-donor weight mismatch ≥10 kg (recipient > donor) or <10 kg (recipient < donor). Multivariable Cox proportional hazards models were applied to evaluate the time to graft loss adjusting for donor, immunologic, surgical, organizational, and recipient predictors. Sex-concordant transplant pairings <10 kg weight difference served as the reference group. Among 826 transplant recipients, 154 developed graft failure (18.6%). Median graft survival time was 3.9 years; first quartile (0.2–1.2), second quartile (1.2–2.9), third quartile (2.9–5.8), and fourth quartile (5.8–12.4). After multivariable adjustment, the highest relative hazard for graft failure was observed for sex-discordant transplant pairings with a ≥10 kg weight difference between recipient and donor (compared to the reference group MDMR/FDFR with weight difference <10 kg, MDMR/FDFR with weight difference ≥10 kg, hazard ratio 1.86, 95% confidence interval 1.07–3.32—p = 0.029; MDFR/FDMR with weight difference <10 kg, hazard ratio 1.14, 95% confidence interval 0.78–1.68—p = 0.507, and MDFR/FDMR with weight difference ≥10 kg, hazard ratio 2.00, 95% confidence interval 1.15–3.48—p = 0.014). A recipient-to-donor weight mismatch of ≥10 kg was associated with an increased risk of graft loss or recipient death with a functioning graft. Concurrent sex discordance seemed to enhance this effect as indicated by an increase in the hazard ratio. We detected no significant tendency for increasing recipient-to-donor weight differences from 2000 to 2012.
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29
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Gustavsen MT, Midtvedt K, Lønning K, Jacobsen T, Reisaeter AV, De Geest S, Andersen MH, Hartmann A, Åsberg A. Evaluation of tools for annual capture of adherence to immunosuppressive medications after renal transplantation - a single-centre open prospective trial. Transpl Int 2019; 32:614-625. [DOI: 10.1111/tri.13412] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 10/19/2018] [Accepted: 02/11/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Marte Theie Gustavsen
- Department of Transplantation Medicine; Oslo University Hospital, Rikshospitalet; Oslo Norway
- School of Pharmacy; University of Oslo; Oslo Norway
| | - Karsten Midtvedt
- Department of Transplantation Medicine; Oslo University Hospital, Rikshospitalet; Oslo Norway
| | - Kjersti Lønning
- Department of Transplantation Medicine; Oslo University Hospital, Rikshospitalet; Oslo Norway
- Faculty of Medicine; Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | | | - Anna Varberg Reisaeter
- Department of Transplantation Medicine; Oslo University Hospital, Rikshospitalet; Oslo Norway
- Norwegian Renal Registry; Oslo University Hospital, Rikshospitalet; Oslo Norway
| | - Sabina De Geest
- Institute of Nursing Science; University of Basel; Basel Switzerland
- Academic Centre for Nursing and Midwifery; KU-Leuven; Leuven Belgium
| | - Marit Helen Andersen
- Department of Transplantation Medicine; Oslo University Hospital, Rikshospitalet; Oslo Norway
- Department of Health Sciences; Faculty of Medicine; University of Oslo; Oslo Norway
| | - Anders Hartmann
- Department of Transplantation Medicine; Oslo University Hospital, Rikshospitalet; Oslo Norway
- Faculty of Medicine; Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - Anders Åsberg
- Department of Transplantation Medicine; Oslo University Hospital, Rikshospitalet; Oslo Norway
- School of Pharmacy; University of Oslo; Oslo Norway
- Norwegian Renal Registry; Oslo University Hospital, Rikshospitalet; Oslo Norway
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30
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Xia M, Yan J, Liu S, Liu J. Beliefs of Immunosuppressive Medication Among Chinese Renal Transplant Recipients, as Assessed in a Cross-Sectional Study With the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Transplant Proc 2019; 51:742-8. [PMID: 30979459 DOI: 10.1016/j.transproceed.2018.10.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/23/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Adherence to immunosuppressive medication (IM) after renal transplantation is crucial to survival of patient and graft outcomes; whether beliefs about IM adherence and other sociodemographic factors affect IM adherence is debatable. OBJECTIVE This study aimed to examine the beliefs on IM and IM adherence in Chinese renal transplant recipients. METHODS Across-sectional survey was conducted. Self-developed IM beliefs questionnaire guided by health belief model was used to measure IM beliefs. The Basel Assessment of Adherence to Immunosuppressive Medications Scale was used to assess drug adherence. RESULTS The nonadherence rate to IM in 208 renal transplant recipients during outpatient follow-up was 44.2%. There were statistically significant associations between adherence and the marital status (P < .001). Perceived seriousness of not taking IM (P < .001) and perceived barriers of taking IM (P < .001) were significantly associated with IM adherence. After controlling other factors, married marital status, high levels of perceived seriousness of not taking IM, and lower levels of perceived barriers of taking IM (P = .007) were significantly associated with IM adherence. CONCLUSION Marital status and IM beliefs are closely association with IM adherence in Chinese renal transplant recipients.
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31
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Lorenz EC, Smith BH, Cosio FG, Schinstock CA, Shah ND, Groehler PN, Verdick JS, Park WD, Stegall MD. Long-term Immunosuppression Adherence After Kidney Transplant and Relationship to Allograft Histology. Transplant Direct 2018; 4:e392. [PMID: 30498769 DOI: 10.1097/TXD.0000000000000824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/10/2018] [Indexed: 01/27/2023] Open
Abstract
Background Nonadherence to immunosuppression after kidney transplant is an important contributor to graft failure. Little is known about how nonadherence changes 3 years posttransplant when Medicare coverage of immunosuppression ends and how that nonadherence impacts allograft histology. The goal of this study was to compare rates of nonadherence during posttransplant years 1 to 3 to years 3 to 5 and examine the relationship between nonadherence during years 3 to 5 and 5-year allograft histology. Methods We retrospectively analyzed 552 conventional kidney allografts in patients transplanted at our center between January 1, 1999, and June 1, 2010, who used the Mayo Clinic Specialty Pharmacy for the first 5 years posttransplant. Nonadherence was defined as less than 80% proportion of days covered. Overall adherence to immunosuppression appeared to be higher during years 3 and 5 compared to between years 1 and 3 (89.4% vs 82.9%, respectively; P < 0.0001 [paired t test]). Results Overall nonadherence during posttransplant years 3 to 5 appeared to be associated with fibrosis and inflammation on 5-year allograft biopsy but not with transplant glomerulopathy (16.9% vs 5.9%, P = 0.004; 10.4% vs 8.5%, P = 0.61, respectively). After adjusting for nonadherence to calcineurin inhibitor and prednisone therapy, only nonadherence to antimetabolite therapy remained significantly associated with 5-year fibrosis and inflammation (odds ratio, 10.6; 95% confidence interval, 1.5-76.1; P = 0.02). Conclusions Efforts to improve long-term adherence, possibly through the use of specialty pharmacies and increased adherence to antimetabolite therapy, may improve long-term allograft histology and survival, although further studies are needed to confirm these findings.
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Ko D, Bratzke LC, Muehrer RJ, Brown RL. Self-management in liver transplantation. Appl Nurs Res 2018; 45:30-38. [PMID: 30683248 DOI: 10.1016/j.apnr.2018.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 10/15/2018] [Accepted: 11/05/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Self-management is crucial for liver transplant (LT) recipients to maintain transplants and optimize health outcomes. However, previous literature has been primarily limited to examining medication adherence; there is a knowledge gap regarding self-management in the LT population. AIM The aims of this study were to 1) comprehensively describe self-management behaviors and activities in LT recipients, 2) explore levels of overall self-management, and 3) explore the relationships of self-efficacy, cognition, and health information seeking behavior with self-management. METHODS Adult LT recipients (n = 113) who had a functioning transplant for at least 6 months participated in this cross-sectional, descriptive study. Participants were asked to identify self-management behaviors and rate their performance of those behaviors, including symptom management and medication adherence. They also completed a cognitive assessment and questionnaires measuring self-efficacy and health information seeking behavior. Descriptive statistics, latent profile analysis, and probit model for path analysis were used for the data analysis. RESULTS LT recipients acknowledged engaging in various self-management behaviors including symptom management, physical activity, maintenance of positive attitudes, and communication with healthcare providers. Three levels of self-management (i.e., low, medium, and high) were found; a high level of self-management was related to self-efficacy and health information seeking behavior. CONCLUSIONS The findings indicate that self-management may be improved with interventions aimed at increasing self-efficacy and health information seeking behavior. Findings from this study will inform future interventions, to improve self-management and subsequent health outcomes in this population. Future longitudinal studies are necessary to confirm the causality of the identified relationships.
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Affiliation(s)
- Dami Ko
- School of Nursing, University of Wisconsin-Madison, 701 Highland Ave., Madison, WI 53705, United States of America.
| | - Lisa C Bratzke
- School of Nursing, University of Wisconsin-Madison, 701 Highland Ave., Room 5127, Madison, WI 53705, United States of America.
| | - Rebecca J Muehrer
- School of Nursing, University of Wisconsin-Madison, 701 Highland Ave., Madison, WI 53705, United States of America
| | - Roger L Brown
- School of Nursing, University of Wisconsin-Madison, 701 Highland Ave., Room 4187, Madison, WI 53705, United States of America.
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Abstract
Optimizing wellness and health are the most critical goals for patients post solid-organ transplantation. Low health literacy has important implications for wellness and health, increasing patient risk for negative health outcomes. More than 30% of the general US patient population has low health literacy, and solid-organ transplant recipients (SOTRs) may be especially vulnerable to low health literacy and its adverse impact on health outcomes. A comprehensive literature review was conducted and a model was adapted to better depict factors associated with low health literacy. Based on the Paasche-Orlow and Wolf model of health literacy, the Health Literacy Model in Transplantation (HeaL-T) provides a foundation to visually demonstrate the relationships among variables associated with low health literacy and to develop evidence-based strategies to improve care. The model depicts a number of patient and healthcare level factors associated with health literacy, several of which have bi-directional or reciprocal relationships, including access and utilization of healthcare, provider-patient interaction, and self-management/adherence. The impact of these factors and their relationships to SOTR outcomes are reviewed. The HeaL-T represents an important step in developing holistic understanding of the complexity of health literacy in SOTRs and offers clinicians a base from which to design strategies to mitigate adverse health effects including increased hospitalizations, graft failure, and mortality.
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Affiliation(s)
| | - Christina A Spivey
- University of Tennessee Health Science Center College of Pharmacy, Department of Clinical Pharmacy and Translational Science, Memphis, TN, USA
| | - Logan R Pickett
- University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA,
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Dew MA, Posluszny DM, DiMartini AF, Myaskovsky L, Steel JL, DeVito Dabbs AJ. Posttransplant Medical Adherence: What Have We Learned and Can We Do Better? Curr Transplant Rep 2018; 5:174-188. [PMID: 30416933 DOI: 10.1007/s40472-018-0195-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Purpose of review Non-adherence to the medical regimen after kidney transplantation can contribute to poor clinical outcomes, and strategies to maximize adherence are sought by care providers and patients alike. We assessed recent evidence on prevalence, risk factors, and clinical outcomes associated with non-adherence to the medical regimen after kidney transplantation. We summarized recent clinical trials testing interventions to improve adherence and generated recommendations for future research and clinical practice. Recent findings A large evidence base documents rates of non-adherence to each of the multiple components of the regimen, including medication-taking, lifestyle activities, clinical care requirements, and substance use restrictions. Some risk factors for non-adherence are well known but the full range of risk factors remains unclear. Non-adherence to immunosuppressants and to other components of the regimen increases morbidity and mortality risks. Recent interventions, including education and counseling; electronic health strategies; and medication dose modifications, show promise for reducing immunosuppressant non-adherence. However, most of these interventions would be difficult to deploy in everyday clinical practice. Systematic dissemination of efficacious interventions into clinical practice has not been undertaken. Summary Rates and risk factors for non-adherence to the medical regimen have been examined and there is evidence that non-adherence may be ameliorated by a range of interventions. Although gaps in the evidence base remain, it would be timely to devote greater efforts to dissemination of findings. Thus, efforts are needed to assist transplant programs in using existing evidence to better identify patients who are non-adherent and to design and implement strategies to reduce or prevent non-adherence.
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Affiliation(s)
- Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.,Departments of Psychiatry, Psychology, Epidemiology, Biostatistics, and the Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Donna M Posluszny
- Department of Medicine and University of Pittsburgh Medical Center Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrea F DiMartini
- Departments of Psychiatry and Surgery and the Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Larissa Myaskovsky
- Department of Internal Medicine, Nephrology Division, and the Center for Healthcare Equity in Kidney Disease, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Jennifer L Steel
- Departments of Surgery, Psychiatry, and Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Annette J DeVito Dabbs
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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Zhao L, Yan J, Yang GL, Liu Y. A Study on Adherence to Follow-up, Quality of Life, and Associated Factors Among Renal Transplant Recipients in China. Transplant Proc 2018; 49:1285-1290. [PMID: 28735995 DOI: 10.1016/j.transproceed.2017.03.086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/01/2017] [Accepted: 03/15/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Adherence to follow-up is vital for the medical surveillance of the postoperative blood concentration, but relatively little research has examined it, and there is less study on relationships between adherence to follow-up and quality of life (QoL). We investigated the status of adherence to follow-up and QoL and associated factors among kidney transplantation recipients in China. METHODS A cross-sectional study with the use of a Kidney Transplantation Recipient's Adherence to Follow-Up Questionnaire and a Quality of Life of Kidney Transplantation Recipients Questionnaire was conducted among 250 kidney transplantation recipients in Changsha, China, from January to March in 2015. RESULTS The mean score for adherence to follow-up was 54.71 ± 6.46. Time after transplantation was the only factor affecting adherence to follow-up scores (β = -0.210; P < .05). The mean total score for QoL was 140.39 ± 13.56; physical functioning, 23.72 ± 3.33; psychologic functioning, 24.46 ± 4.23; social functioning, 44.43 ± 6.80; treatment, 24.81 ± 2.97; and subjective satisfaction, 21.28 ± 3.15. Multiple linear regression analysis showed that adherence to follow-up, economic level, job status, donor source, and original disease affected with QoL. CONCLUSIONS Adherence to follow-up decreases with time after transplantation, and better compliance is associated with better QoL in all areas. Improvements in adherence to follow-up, income and reimbursement, psychologic guidance, and social support may increase QoL of kidney transplantat recipients.
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Affiliation(s)
- L Zhao
- Xiangya Nursing School, Central South University, Changsha, People's Republic of China; School of Nursing, University of South China, Heangyang, People's Republic of China
| | - J Yan
- Department of Nursing, Third Xiangya Hospital, Changsha, People's Republic of China
| | - G-L Yang
- Organ Transplantation Center, Third Xiangya Hospital, Changsha, People's Republic of China
| | - Y Liu
- Organ Transplantation Center, Third Xiangya Hospital, Changsha, People's Republic of China.
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Sanders-Pinheiro H, Colugnati FAB, Marsicano EO, De Geest S, Medina JOP. Prevalence and correlates of non-adherence to immunosuppressants and to health behaviours in patients after kidney transplantation in Brazil - the ADHERE BRAZIL multicentre study: a cross-sectional study protocol. BMC Nephrol 2018; 19:41. [PMID: 29463231 PMCID: PMC5819659 DOI: 10.1186/s12882-018-0840-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 02/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-adherence to immunosuppressive therapy is a prevalent risk factor for poor clinical and after kidney transplantation (KT), and has contributed to the lack of improvement in long-term graft survival over the past decade. Understanding the multilevel correlates and risk factors of non-adherence is crucial to determine the optimal level for planning interventions, namely at the patient, health care provider, KT centre, and health care system level. Brazil, having the largest public transplantation program in the world and with regional differences regarding access to health services and service implementation, is in a unique position to study this multilevel approach. Therefore, the Adhere Brazil Study (ADHERE BRAZIL) was designed to assess the prevalence and variability of non-adherence to immunosuppressants and to health behaviours among adult KT recipients in Brazil, and to assess the multilevel correlates of non-adherence to immunosuppressive medication. We describe the rationale, design, and methodology of the ADHERE BRAZIL study. METHODS/DESIGN This is an observational, cross-sectional, multicentre study that includes 20 Brazilian KT centres. A stratified sampling approach is used, based on strata, with the following characteristics considered: geographical region and transplant activity (number of KTs per year). A random sample of patients (proportional to the size of the centre within each stratum) is selected from each centre. The prevalence of different health behaviours is assessed through self-report. The assessment of multilevel correlates of non-adherence is guided by the ecological model that considers factors at the level of the patient, health-care professional, and transplant centre, using established instruments or instruments developed for this study. Data will be collected over an 18-month period, with information obtained during the regular follow-up visits to the transplant outpatient clinic and directly entered into the Research Electronic Data Capture (RedCap) system. Data entry is performed by a trained professional who is part of the transplant team. The data collection began in December 2015. DISCUSSION This multicentre study is the first to evaluate multilevel correlates of non-adherence in KT patients and will provide a reliable estimate of non-adherence in Brazilian KT patients. TRIAL REGISTRATION ClinicalTrials.gov on 10/10/2013, NCT02066935 .
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Affiliation(s)
- Helady Sanders-Pinheiro
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Rua Benjamin Constant, 1044/1001, Juiz de Fora, MG 36015-400 Brazil
- Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia [NIEPEN], Rua Benjamin Constant, 1044/1001, Juiz de Fora, MG 36015-400 Brazil
| | - Fernando Antonio Basile Colugnati
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Rua Benjamin Constant, 1044/1001, Juiz de Fora, MG 36015-400 Brazil
- Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia [NIEPEN], Rua Benjamin Constant, 1044/1001, Juiz de Fora, MG 36015-400 Brazil
| | - Elisa Oliveira Marsicano
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Rua Benjamin Constant, 1044/1001, Juiz de Fora, MG 36015-400 Brazil
- Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia [NIEPEN], Rua Benjamin Constant, 1044/1001, Juiz de Fora, MG 36015-400 Brazil
| | - Sabina De Geest
- Institute of Nursing Science, Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine, KU-Leuven, Leuven, Belgium
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Lepeytre F, Dahhou M, Zhang X, Boucquemont J, Sapir-Pichhadze R, Cardinal H, Foster BJ. Association of Sex with Risk of Kidney Graft Failure Differs by Age. J Am Soc Nephrol 2017; 28:3014-3023. [PMID: 28592422 DOI: 10.1681/asn.2016121380] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 04/29/2017] [Indexed: 12/31/2022] Open
Abstract
Prior studies of sex differences in kidney graft survival showed conflicting results. We hypothesized that the association between recipient sex and kidney graft failure risk differs by recipient age and donor sex. We evaluated 159,417 patients recorded in the Scientific Registry of Transplant Recipients database who received a first deceased-donor kidney transplant (1995-2013). We used time-varying Cox models to estimate the association between recipient sex and death-censored graft failure. Models, stratified on donor sex and adjusted for potential confounders, included a recipient sex by current age interaction term. Among recipients of male donors, females of all ages had significantly higher graft failure risks than males (adjusted hazard ratios 0-14 years: 1.51 [95% confidence intervals 1.19 to 1.90]; 15-24 years: 1.37 [1.18 to 1.59]; 25-44 years: 1.14 [1.03 to 1.26]; 45 years: 1.05 [1.01 to 1.09]). Among recipients of female-donor grafts, only female recipients aged 15-24 years had a significantly higher graft failure risk than their male counterparts had (1.28 [1.06 to 1.53]). Indeed, female recipients aged ≥45 years had a significantly lower graft failure risk than their male counterparts had (0.95 [0.91 to 0.99]). These observations might be explained by the combined influence of several factors, including recognition of sex-determined minor histocompatibility antigens, influence of sex hormones on immune activation, sex- and age-related differences in medication adherence, and sex-related differences in body size. Additional studies should determine whether sex- and age-specific immunosuppression strategies are warranted for kidney graft recipients.
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Affiliation(s)
- Fanny Lepeytre
- Department of Medicine, Nephrology Division and Research Center, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Mourad Dahhou
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Xun Zhang
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Julie Boucquemont
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; and
| | - Ruth Sapir-Pichhadze
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; and.,Departments of Medicine and
| | - Heloise Cardinal
- Department of Medicine, Nephrology Division and Research Center, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Bethany J Foster
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; .,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; and.,Pediatrics, Division of Nephrology, McGill University Faculty of Medicine, Montreal, Quebec, Canada
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Belaiche S, Décaudin B, Dharancy S, Noel C, Odou P, Hazzan M. Factors relevant to medication non-adherence in kidney transplant: a systematic review. Int J Clin Pharm 2017; 39:582-593. [PMID: 28374343 DOI: 10.1007/s11096-017-0436-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 02/06/2017] [Indexed: 01/14/2023]
Abstract
Background Medication non-adherence is a major issue after transplant that can lead to misdiagnosis, rejection, poor health affecting quality of life, graft loss or death. Several estimations of adherence and related factors have previously been described but conclusions leave doubt as to the most accurate assessment method. Aim of the review To identify the factors most relevant to medication non-adherence in kidney transplant in current clinical practice. Method This systematic review is registered in the PROSPERO data base and follows the Prisma checklist. Articles in English in three databases from January 2009 to December 2014 were analysed. A synthesis was made to target adherence assessment methods, their prevalence and significance. Results Thirty-seven studies were analysed rates of non-adherence fluctuating from 1.6 to 96%. Assessment methods varied from one study to another, although self-reports were mainly used. It appears that youth (≤50 years old), male, low social support, unemployment, low education, ≥3 months post graft, living donor, ≥6 comorbidities, ≥5 drugs/d, ≥2 intakes/d, negative beliefs, negative behavior, depression and anxiety were the factors significantly related to non-adherence. Conclusion As there are no established guidelines, consideration should be given to more than one approach to identify medication non-adherence although self-reports should remain the cornerstone of adherence assessment.
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Affiliation(s)
- Stephanie Belaiche
- Institut de pharmacie, CHU Lille, 59000, Lille, France. .,EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Univ. Lille, 59000, Lille, France.
| | - Bertrand Décaudin
- Institut de pharmacie, CHU Lille, 59000, Lille, France.,EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Univ. Lille, 59000, Lille, France
| | - Sébastien Dharancy
- Service des Maladies de l'appareil digestif et de la Nutrition, CHU Lille, 59000, Lille, France.,Inserm U995 - LIRIC - Lille Inflammation Research International Center, Univ. Lille, 59000, Lille, France
| | - Christian Noel
- Service de Néphrologie, CHU Lille, 59000, Lille, France.,Inserm U995 - LIRIC - Lille Inflammation Research International Center, Univ. Lille, 59000, Lille, France
| | - Pascal Odou
- Institut de pharmacie, CHU Lille, 59000, Lille, France.,EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Univ. Lille, 59000, Lille, France
| | - Marc Hazzan
- Service de Néphrologie, CHU Lille, 59000, Lille, France.,Inserm U995 - LIRIC - Lille Inflammation Research International Center, Univ. Lille, 59000, Lille, France
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Foster BJ, Gupta IR. Donor Quality in the Eye of the Beholder: Interactions between Nonimmunologic Recipient and Donor Factors as Determinants of Graft Survival. Clin J Am Soc Nephrol 2017; 12:565-567. [PMID: 28360197 PMCID: PMC5383376 DOI: 10.2215/cjn.02180217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Bethany J Foster
- Department of Pediatrics, Montreal Children's Hospital of the McGill University Health Centre, McGill University, Quebec, Canada
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Weng LC, Yang YC, Huang HL, Chiang YJ, Tsai YH. Factors that determine self-reported immunosuppressant adherence in kidney transplant recipients: a correlational study. J Adv Nurs 2016; 73:228-239. [DOI: 10.1111/jan.13106] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Li-Chueh Weng
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
- Department of General Surgery; Chang Gung Medical Foundation-Linkuo; Taoyuan Taiwan
| | - Ya-Chen Yang
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Hsiu-Li Huang
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
- Department of Neurology; Chang Gung Medical Foundation-Linkuo; Taoyuan; Taiwan
| | - Yang-Jen Chiang
- Transplantation Center and Urology Surgery; Chang Gung Medical Foundation-Linkuo Medical Center; Taoyuan Taiwan
| | - Yu-Hsia Tsai
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
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Costa-Requena G, Cantarell MC, Moreso F, Parramon G, Seron D. [Adherence to treatment after kidney transplantation as quality indicator of the information received: Longitudinal study of 2 years follow-up]. ACTA ACUST UNITED AC 2016; 32:33-39. [PMID: 27425627 DOI: 10.1016/j.cali.2016.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/05/2016] [Accepted: 05/06/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Transplantation is an optimal form of treatment for end-stage renal disease, but requires lifelong adherence to immunosuppressive therapy. The aim of this study was to longitudinally assess the adherence to treatment after kidney transplant, as well as to compare the amount of information about the treatment received at one month and 18 months post-transplantation, and its influence on adherence to treatment. MATERIAL AND METHODS The Self-Reported Measure of Medication Adherence was administered at month (T1), 6 months (T2), 12 months (T3), 18 months (T4), and 24 months (T5) post-transplantation. Survey about aspects of knowledge and attitudes about medication, was administered at one month and 18 months post-transplant. Measures of central tendency and non-parametric tests were used to compare the data. RESULTS The study included a total of 73 patients with a median age of 57 years. The percentage of patients non-adherent to medication was 9.6% (T1), 22.5% (T2), 29.2% (T3), 29.8% (T4), and 28.1% (T5). One month after transplantation "not consulting with the doctor on forgetting to take medication (P=.034) significantly influenced the non-adherence to treatment. At 18 months post- transplantation, none of the issues raised on medication knowledge had an influence on non-adherence to treatment. CONCLUSIONS Longer times since transplantation increased the non-adherence to treatment. Some issues regarding the information of treatment influenced the non-adherence in the immediate transplant period, but not in the follow-up.
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Affiliation(s)
- G Costa-Requena
- Servicio de Psiquiatría, Hospital General Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, España.
| | - M C Cantarell
- Servicio de Nefrología, Hospital General Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - F Moreso
- Servicio de Nefrología, Hospital General Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - G Parramon
- Servicio de Psiquiatría, Hospital General Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, España
| | - D Seron
- Servicio de Nefrología, Hospital General Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
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Abstract
BACKGROUND Medication therapy management (MTM) services among patient populations with a range of disease states have improved adherence rates. However, no published studies have examined the impact of Medicare Part D MTM eligibility on renal transplant recipients' (RTRs) immunosuppressant therapy (IST) adherence. This study's purpose was therefore, to determine the effects of Medicare Part D MTM on IST adherence among adult RTRs at 12 months posttransplant. METHODS Cross-sectional analyses were performed on Medicare Parts A, B, and D claims and transplant follow-up data reported in the United States Renal Data System. The sample included adult RTRs who were transplanted between 2006 and 2011, had graft survival for 12 months, were enrolled in Part D, and were prescribed tacrolimus. IST adherence was measured by medication possession ratio for tacrolimus. MTM eligibility was determined using criteria established by the Centers for Medicare and Medicaid Services. Descriptive statistics were calculated. Adherence was modeled using multiple logistic regression. RESULTS In all, 17,181 RTRs were included. The majority of the sample were male (59.1%), and 42% were MTM-eligible. Mean medication possession ratio was 0.91±0.17 (mean ± standard deviation), with 16.83% having a medication possession ratio of <0.80. MTM eligibility, sex, age, and number of prescription drugs were significantly associated with adherence in the full model (P<0.05). MTM-eligible RTRs were more likely to be adherent than those who were not MTM-eligible (odds ratio =1.13, 95% confidence interval 1.02-1.26, P=0.02). CONCLUSION The findings provide evidence that access to MTM services increases IST adherence among RTRs.
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Affiliation(s)
- Marie A Chisholm-Burns
- Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis, TN, USA
| | - Christina A Spivey
- Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis, TN, USA
| | - Elizabeth A Tolley
- Department of Preventive Medicine, University of Tennessee College of Medicine, Memphis, TN, USA
| | - Erin K Kaplan
- Department of Preventive Medicine, University of Tennessee College of Medicine, Memphis, TN, USA
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Jamieson NJ, Hanson CS, Josephson MA, Gordon EJ, Craig JC, Halleck F, Budde K, Tong A. Motivations, Challenges, and Attitudes to Self-management in Kidney Transplant Recipients: A Systematic Review of Qualitative Studies. Am J Kidney Dis 2016; 67:461-78. [DOI: 10.1053/j.ajkd.2015.07.030] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 07/19/2015] [Indexed: 12/20/2022]
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Shokati T, Bodenberger N, Gadpaille H, Schniedewind B, Vinks AA, Jiang W, Alloway RR, Christians U. Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS. J Vis Exp 2015:e52424. [PMID: 26575262 DOI: 10.3791/52424] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The calcineurin inhibitor tacrolimus is the cornerstone of most immunosuppressive treatment protocols after solid organ transplantation in the United States. Tacrolimus is a narrow therapeutic index drug and as such requires therapeutic drug monitoring and dose adjustment based on its whole blood trough concentrations. To facilitate home therapeutic drug and adherence monitoring, the collection of dried blood spots is an attractive concept. After a finger stick, the patient collects a blood drop on filter paper at home. After the blood is dried, it is mailed to the analytical laboratory where tacrolimus is quantified using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) in combination with a simple manual protein precipitation step and online column extraction. For tacrolimus analysis, a 6-mm disc is punched from the saturated center of the blood spot. The blood spot is homogenized using a bullet blender and then proteins are precipitated with methanol/0.2 M ZnSO4 containing the internal standard D2,(13)C-tacrolimus. After vortexing and centrifugation, 100 µl of supernatant is injected into an online extraction column and washed with 5 ml/min of 0.1 formic acid/acetonitrile (7:3, v:v) for 1 min. Hereafter, the switching valve is activated and the analytes are back-flushed onto the analytical column (and separated using a 0.1% formic acid/acetonitrile gradient). Tacrolimus is quantified in the positive multi reaction mode (MRM) using a tandem mass spectrometer. The assay is linear from 1 to 50 ng/ml. Inter-assay variability (3.6%-6.1%) and accuracy (91.7%-101.6%) as assessed over 20 days meet acceptance criteria. Average extraction recovery is 95.5%. There are no relevant carry-over, matrix interferences and matrix effects. Tacrolimus is stable in dried blood spots at RT and at +4 °C for 1 week. Extracted samples in the autosampler are stable at +4 °C for at least 72 hr.
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Affiliation(s)
- Touraj Shokati
- iC42 Clinical Research and Development, University of Colorado, Anschutz Medical Campus
| | - Nicholas Bodenberger
- iC42 Clinical Research and Development, University of Colorado, Anschutz Medical Campus
| | - Holly Gadpaille
- iC42 Clinical Research and Development, University of Colorado, Anschutz Medical Campus
| | - Björn Schniedewind
- iC42 Clinical Research and Development, University of Colorado, Anschutz Medical Campus
| | - Alexander A Vinks
- Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center
| | - Wenlei Jiang
- Food and Drug Administration (FDA), Center of Drug Evaluation Research - Office of Generic Drugs
| | | | - Uwe Christians
- iC42 Clinical Research and Development, University of Colorado, Anschutz Medical Campus;
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Taber DJ, Pilch NA, Trofe-Clark J, Kaiser TE. A National Survey Assessing the Current Workforce of Transplant Pharmacists Across Accredited U.S. Solid Organ Transplant Programs. Am J Transplant 2015; 15:2683-90. [PMID: 25988533 DOI: 10.1111/ajt.13323] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/08/2015] [Accepted: 03/20/2015] [Indexed: 01/25/2023]
Abstract
Integration of pharmacists into multidisciplinary transplant patient care has advanced in recent years, with limited data available to evaluate the current status of the profession. This was a national survey developed as an AST Pharmacy COP initiative. Responses were solicited from pharmacists practicing at U.S. transplant programs based on UNOS listing; 176 participants from 113 centers (41%) responded, with 79% practicing ≤10 years. There is a median of 1.4 pharmacist full-time equivalents (FTEs) (range 0.1-7.1) for every 100 transplants. The predominant activities performed by pharmacists during the transplant phase include medication review (95%), lab review (92%), allergy review (88%), medication therapy management (92%), bedside rounds (87%), medication education (79%), documentation (71%), and coordinating discharge medications (58%). Similar activities were reported during the other phases, but participation was less common. The involvement of dedicated transplant pharmacists within multidisciplinary care has become standard at a large number of centers, although expansion is still needed to ensure core pharmaceutical care components are provided to all transplant recipients across all centers. These results inform on the typical responsibilities of pharmacists practicing within the field of transplantation and illustrate that the level of pharmacist involvement significantly varies across transplant centers and the phases of transplantation.
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Affiliation(s)
- D J Taber
- Department of Pharmacy, Ralph H. Johnson VA Medical Center, Charleston, SC.,Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC
| | - N A Pilch
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC
| | - J Trofe-Clark
- Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, PA.,Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - T E Kaiser
- College of Medicine, University of Cincinnati, Cincinnati, OH
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Muduma G, Odeyemi I, Smith-Palmer J, Pollock RF. Budget impact of switching from an immediate-release to a prolonged-release formulation of tacrolimus in renal transplant recipients in the UK based on differences in adherence. Patient Prefer Adherence 2014; 8:391-9. [PMID: 24729687 PMCID: PMC3974691 DOI: 10.2147/ppa.s60213] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND AIMS Advagraf is a once-daily prolonged-release formulation of tacrolimus with proven noninferiority to Prograf, a twice-daily immediate-release formulation of tacroli-mus, in biopsy-proven acute rejection, graft survival and patient survival in renal transplant recipients. Advagraf is associated with improved adherence compared with Prograf, which may ultimately improve long-term outcomes. The present study assessed the budget impact of switching patients from Prograf to Advagraf in the UK. MATERIALS AND METHODS A budget-impact model was constructed based on published data on acute rejection, graft failure, and mortality in the UK setting. Patients were assumed to convert from Prograf to Advagraf on a 1:1 milligram:milligram basis. In a study comparing the adherence rates between once-daily versus twice-daily formulations of tacrolimus, the proportion of patients taking the prescribed number of daily doses was 88.2% in Advagraf patients and 78.8% in Prograf patients. The model applied a relative risk of graft failure of 3.47 to nonadherent patients based on data from a 2004 meta-analysis (based on graft-failure rates of 1.3%-40.0% in adherent patients, compared with 6.1%-100% in nonadherent patients). Cost data were taken from the March 2013 British National Formulary and 2012-2013 National Health Service tariff information. The analysis was performed over a 5-year time horizon and future costs were not discounted, in line with International Society for Pharmacoeconomics and Outcomes Research guidelines. RESULTS Over a 5-year time horizon, the mean cost per patient (including tacrolimus, concomitant immunosuppressive medications, dialysis after graft failure, and treatment for acute rejection) was £29,328 (standard deviation [SD] £2,844) for Advagraf versus £33,061 (SD £3,178) for Prograf. The total cost saving of £3,733 (SD £530) was driven primarily by reduced dialysis costs arising from the lower incidence of graft failure (21.6% with Prograf versus 18.3% with Advagraf) in the larger proportion of adherent patients in the Advagraf arm. In a hypothetical transplant centre of 100 kidney-transplant recipients, this would result in cost savings approaching £375,000 over 5 years. CONCLUSION Conversion of renal transplant recipients from Prograf to Advagraf was associated with lower pharmacy and dialysis costs, with the reduction in dialysis costs being driven by improved adherence to Advagraf regimen and the consequent improvement in graft survival.
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Affiliation(s)
| | | | | | - Richard F Pollock
- Ossian Health Economics and Communications, Basel, Switzerland
- Correspondence: Richard F Pollock, Ossian Health Economics and Communications, 20 Bäumleingasse, Basel 4051, Switzerland, Tel +41 61 271 6214, Email
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