Introduction

KDIGO define nonadherence to immunosuppression as a 'deviation from the prescribed medication regimen sufficient to adversely influence the regimen's intended effect'. There is however, no agreed standard by which to measure nonadherence post-transplant and no agreed taxonomy in order to define adherence in terms of the number of missed doses, the early/late administration of doses, the measurement of subtherapeutic or highly variable tacrolimus levels or other criteria by which we may assess the patient as being nonadherent in clinical practice. The absence of a taxonomy has led to confusion in the literature with different authors using arbitrary cut-offs or percentages to classify patients as adherent or nonadherent. The aim of this study was to develop a classification for immunosuppressant medication nonadherence to enable its objective and consistent measurement in transplant patients.

Methods

A stakeholder group was set up consisting of transplant nephrologists, surgeons, nurses, pharmacists and patients. The project lead reviewed the current immunosuppressant medication adherence literature which was summarised and used to develop a list of the criteria which had been used most commonly to define nonadherence. Each of these criteria were discussed and a classification agreed for each to enable the objective and consistent measurement of nonadherence which also takes account of the associated risk to the patient and to their graft.

Results

A tool was developed which lists each criterion identified in the classification of immunosuppressant medication nonadherence, how that criterion will be objectively measured, the adherence rating and an overall adherence score. The tool is presented below:

Conclusion

The classification of immunosuppression medication nonadherence is complex and lacks formal agreement in the literature. This classification tool will enable the objective and consistent measurement of immunosuppressant medication nonadherence in kidney transplant patients. The tool will be piloted prospectively in a group of transplant patients.

CITATION INFORMATION: Goodall D., Willicombe M., McLean A., Taube D. Development of a Classification of Immunosuppressant Medication Nonadherence Tool to Enable the Objective Measurement of Immunosuppressant Medication Nonadherence in Kidney Transplant Patients Am J Transplant. 2017;17 (suppl 3).

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