*Purpose: To determine if patients who receive financial assistance through the American Kidney Fund (AKF) for health care premiums at the time of transplant are at higher risk of medication misadventure.

*Methods: We conducted a retrospective analysis of renal transplant recipients at the University of Colorado Hospital between 4/27/18 – 9/30/18. Patient insurance coverage at the time of transplant was assessed to determine if they received financial assistance from the AKF. Specific medication misadventures measured include: inability to afford medications at time of hospital discharge or requirement to enroll in medication assistance programs. Both of which may increase the risk for medication non-adherence and resulting antibody mediated adverse outcomes. Clinical outcome measures at 1 month included frequency of de novo donor specific antibody development and percent of donor-derived cell-free DNA (dd-cfDNA, AlloSure) testing.

*Results: Data was collected on a total of 122 renal transplant recipients. 23 of those patients had received financial assistance from the American Kidney Fund. At one month post-transplant, a total of 7 patients had an AlloSure of ≥1% occurring in 2/23 (8.7%) of those patients having received AKF financial assistance vs. 5/99 (5%) of those without assistance. Also, at one month post-transplant, a total of 18 patients had de novo donor specific antibodies, with 5/23 (21.7%) frequency in the AKF financial assistance group vs. 13/99 (13%) of patients who did not receive assistance. When looking at patients who had medication misadventures at the time of discharge, 6/23 (26%) patients who received AKF assistance had issues vs. 11/99 (11.1%) patients who did not require AKF assistance. This included patients that were unable to afford medication copays or were required to enroll in medication assistance programs through drug manufacturers.

*Conclusions: These preliminary findings suggest resources should be directed toward patients receiving assistance through the AKF prior to transplant to minimize medication misadventures after transplant. Thereby, potentially decreasing the risk of medication non-adherence and resulting antibody mediated adverse outcomes.

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