Background: Despite the advent of modern immunosuppression, long term renal allograft outcomes have remained relatively unchanged. In the renal transplant population, medical nonadherence is a major risk factor for allograft failure. We performed a ten year retrospective review, of our renal transplant database, to determine whether nonadherence is a common etiology for allograft failure.

Methods: Recognizing that nonadherence is complex and variable, we defined medical nonadherence as a documented history of no immunosuppression for seven or more consecutive calendar days and/or ≥ 3 absences from clinical appointments in one calendar year. A retrospective review of our renal transplant database was performed to determine which transplant recipients had lost their allograft. For those subjects, a thorough review of their medical records was performed to determine the etiology of allograft failure. Statistical analysis was restricted to those individuals who experienced graft loss.

Results: Over a ten year period, a total of 838 kidney transplants were performed. Fifty nine recipients lost their renal allograft. Overall, medical nonadherence was the most common etiology for allograft loss (32.2%), followed by primary nonfunction (30.5%), death with a functioning allograft (13.6%), and acute rejection (10.2%). Analysis of individual patient characteristics demonstrated that age ≤ 50 at the time of transplant was the only variable significantly associated with nonadherence (84.2% vs. 55.0% in other causes of allograft loss; p=0.04). Multivariatelogistic regression analysis revealed that recipient age ≤ 50 predicted nonadherence as a cause of allograft loss (OR, 4.89; 95%CI, 1.17-20.40; p=0.03), independent of gender, race, cadaveric vs. live donor, and single vs. dual organ transplant.

Conclusion: This current study demonstrates that medical nonadherence is the most common etiology for allograft failure at our center. Although these results cannot necessarily be extrapolated to the entire renal transplant population, it nonetheless highlights that nonadherence is frequently the cause of allograft failure. A better understanding of this challenging problem has the potential to improve long term renal transplant outcomes.

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