Assessment of HEALTh LIteracy on MEdication ADheREnce and Graft Outcomes in KIdney Transplant Recipients (Hallmark)

M. Leung¹, A. Dhanda², S. Kwan³, A. Zienkiewicz³, E. Waters³, N. Wood³, L. Young³, C. Bannon³

¹Pharmacy, St. Paul's Hospital, Vancouver, BC, Canada, ²Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada, ³Nephrology, St. Paul's Hospital, Vancouver, BC, Canada

Meeting: 2020 American Transplant Congress

Abstract number: B-251

Keywords: Kidney transplantation, Psychosocial

Session Information

Session Name: Poster Session B: Psychosocial and Treatment Adherence

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: Upon successful kidney transplantation, many patients have difficulty adhering to their new immunosuppression medication regimens. Previous studies have established low health literacy to be independently associated with lower immunosuppressant adherence and adverse outcomes in kidney transplant recipients. Our study investigated if targeted medication adherence interventions based on the health literacy level of the kidney transplant recipients could improve medication adherence and graft outcomes.

*Methods: A prospective, open label, interventional design trial in living and deceased donor kidney transplant recipients at a tertiary transplant center. Consent was obtained immediately post-transplant. Patients under the age of 18, with limited English language abilities or patients unable to complete health literacy surveys were excluded. Once consented, patients were administered validated health literacy tests: New Vital Signs (NVS) & Short Literacy Survey (SLS). Target interventions were provided in the low health literacy group, such as motivational interviewing, adherence device, caregiver support, etc. Data on demography, adherence scores, graft function (serum creatinine, urine ACR) and tacrolimus trough level variability (coefficient variation and percentage within target) were collected. Adherence rates and clinical outcomes were compared with high and low health literacy groups.

*Results: One hundred and six patients were included for analysis (75.4% men, 24.5% women). Patients were stratified by high or low literacy based on NVS and SLS scores (Table 1). No statistically significant difference was found in terms of adherence, tacrolimus level variability and acute rejection rate at one year. Slightly higher urine ACR was found in high vs low health literacy groups for both NVS and SLS, respectively,14.0 mg/mmol vs 6.3 (p= 0.00003), 14.1 vs 0.7 (p=3.49E-7). However, the study was limited by the small sample size enrolled in the low health literacy category, NVS (n=13) and SLS (n=8).

*Conclusions: No differences in clinical outcomes were identified between kidney transplant recipients with high and low health literacy scores after targeted interventions. We hope this study will encourage future studies to establish the role of health literacy in both adherence and ultimately kidney graft function.

Table 1. Outcomes between High and Low Health Literacy Scores
	High NVS Scores, 4-6 (n=93)	Low NVS Scores, 1-3 (n=13)	p-value	High SLS Scores, 10-15 (n=98)	Low SLS Scores, 1-9 (n=8)	p-value
% tacrolimus levels within target	47.0%	55.7%	0.303	48.0%	47.9%	0.33
Tacrolimus level coefficient variations	25.9	22	0.117	25	26	0.443
SCr at 1 year (umol/L)	120	147	0.167	124	112	0.188
ACR at 1 year (mg/mmol)	14	6.3	0.00003	14	0.72	3.49E-07
# acute rejection	7	1		7	1
BAASIS adherence at 1 mo post transplant	98.2%	96.4%	0.363	98.0%	98.3%	0.424
BAASIS adherence at 3 mo post transplant	97.7%	97.3%	0.058	97.6%	98.5%	0.246

To cite this abstract in AMA style:

Leung M, Dhanda A, Kwan S, Zienkiewicz A, Waters E, Wood N, Young L, Bannon C. Assessment of HEALTh LIteracy on MEdication ADheREnce and Graft Outcomes in KIdney Transplant Recipients (Hallmark) [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/assessment-of-health-literacy-on-medication-adherence-and-graft-outcomes-in-kidney-transplant-recipients-hallmark/. Accessed June 6, 2025.

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