Differences in Medication Adherence Between Preemptive and Post-Dialysis Young Kidney Transplant Recipients

Y. Vaisbourd¹, E. Samson², A. De Simone², M. Dahhou², B. Foster³

¹Pediatrics, McGill University, Montréal, QC, Canada, ²McGill University, Montréal, QC, Canada, ³Montreal Children's Hospital, Montreal, QC, Canada

Meeting: 2022 American Transplant Congress

Abstract number: 447

Keywords: Ethics, Kidney transplantation, N/A, Patient education

Topic: Clinical Science » Ethics » 22 - Psychosocial and Treatment Adherence

Session Information

Session Name: Psychosocial and Treatment Adherence

Session Type: Rapid Fire Oral Abstract

Date: Tuesday, June 7, 2022

Session Time: 3:30pm-5:00pm

Presentation Time: 3:50pm-4:00pm

Location: Hynes Room 311

*Purpose: The mechanisms underlying the superior graft survival associated with pre-emptive kidney transplantation, compared with transplantation following a period of dialysis, are unknown. Selection for pre-emptive transplantation of a group biased to better treatment adherence is possible. We aimed to compare medication adherence between pre-emptively transplanted young kidney transplant recipients and those who received a transplant after an interval of dialysis.

*Methods: This was a secondary analysis of the Teen Adherence in Kidney transplant Effectiveness of Intervention Trial (TAKE-IT),in which adherence was assessed with electronic monitors over a 15-month period among 11-24 year-old kidney transplant recipients. Adherence scores were calculated daily as 0%, 50%, or 100%, depending on whether the patient took none, half, or all prescribed doses. We used ordinal logistic regression to estimate the association between pre-emptive transplantation and adherence, with generalized estimating equations to account for repeated measures within each participant. The model was adjusted for sex, age at transplant, time since transplant, primary kidney disease, race, donor source, medication insurer, household income, and adherence intervention (time-varying).

*Results: There were 43 pre-emptive transplant recipients (median age 15.8 [IQR 13.7-17.6]; 60.5% male) and 103 who has been treated with dialysis (median age 15.7 [IQR 13.3-17.4]; 60.2% male). The mean adherence score was 85.1% (IQR 81.3-88.9) for those pre-emptively transplanted, and 80.0% (IQR 76.7-83.4) for those transplanted after dialysis. Table 1 shows the results of the unadjusted and adjusted logistic regression models. Preemptively transplanted recipients were significantly more likely to be adherent than those dialyzed before transplantation (OR 1.76 95%CI 1.21-2.55; p=0.003).

*Conclusions: Pre-emptively transplanted patients showed significantly better adherence than those treated with dialysis before transplantation. This suggests that the superior outcomes observed among preemptive kidney transplant recipients likely reflect selection of patients more likely to adhere to therapy.

Table 1. Association between pre-emptive transplantation and likelihood of adherence
	Unadjusted OR (95% CI)	Adjusted OR (95% CI)
Preemptive transplantation (vs post-dialysis transplantation)	1.48 (1.02, 2.15; p=0.04)	1.76 (1.21,2.55); p=0.003

To cite this abstract in AMA style:

Vaisbourd Y, Samson E, Simone ADe, Dahhou M, Foster B. Differences in Medication Adherence Between Preemptive and Post-Dialysis Young Kidney Transplant Recipients [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/differences-in-medication-adherence-between-preemptive-and-post-dialysis-young-kidney-transplant-recipients/. Accessed November 21, 2024.

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