Poor adherence to immunosuppressive medications limits long-term renal allograft survival. Using data from the 3-month run-in (no intervention) of the randomized trial TAKE-IT, which tests an adherence intervention vs usual care, we aimed to characterize taking and timing adherence patterns among young kidney transplant recipients. Identification of patient characteristics associated with unfavorable patterns may allow targeted intervention.

Adherence was monitored with a multidose electronic pillbox in 120 patients (62% male; 65% white; median baseline age 16.0y [IQR 13.7-17.5]; median time since transplant 2.9y [IQR 0.8-7.1]) followed in 8 transplant centers in Canada and USA. We used latent class growth analysis to identify adherence trajectories shared by groups of patients. Model goodness-of-fit was assessed using the Bayesian Information Criterion. We identified 4 profiles for each of taking (% prescribed doses taken) and timing (% doses taken on time) adherence: stable near-perfect adherence, stable good adherence, high baseline adherence followed by a decline, and low baseline adherence followed by an improvement. For both taking and timing models, discrimination between classes was excellent with a mean probability of membership in the assigned class of >0.88 for all classes after posterior classification. 94% of patients had the same pattern for taking and timing. In multinomial logistic regression including sex, race, baseline age, and time since transplant at baseline, only time since transplant was associated with class membership for taking adherence (p=0.02). Participants with stable near-perfect adherence had a longer time since transplant than those with other patterns. A similar tendency was observed for timing adherence. This may reflect survival bias, whereby only the most adherent have many years of graft survival. Future analyses will determine stability of adherence patterns over time and if intervention influences the trajectory.

We identified 4 distinct adherence trajectories; adherence patterns were significantly associated with time since transplant.

CITATION INFORMATION: Boucquemont J, Foster B, The TAKE-IT Investigators Adherence Patterns in Adolescent and Young Adult Kidney Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).

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