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Multilevel Correlates of Immunosuppressive Nonadherence in Kidney Transplant Patients – The Multicenter ADHERE BRAZIL Study

H. Sanders-Pinheiro1, F. A. Colugnati1, K. Denhaerynck2, E. O. Marsicano1, J. O. Medina3, S. De Geest2, A. ADHERE BRAZIL Study team1

1Nephrology, Federal University of Juiz de Fora, Juiz de Fora, Brazil, 2Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland, 3Hospital do Rim e Hipertensão/Nephrology, Federal University of São Paulo, São Paulo, Brazil

Meeting: 2019 American Transplant Congress

Abstract number: D318

Keywords: Multicenter studies, Multivariate analysis, Psychosocial, Risk factors

Session Information

Session Name: Poster Session D: Psychosocial and Treatment Adherence

Session Type: Poster Session

Date: Tuesday, June 4, 2019

Session Time: 6:00pm-7:00pm

 Presentation Time: 6:00pm-7:00pm

Location: Hall C & D

*Purpose: Nonadherence to immunosuppressive therapy is a risk factor for poor clinical and economic outcomes after kidney transplantation (KT). Brazil, having the largest public and full coverage transplantation program in the world, is a unique opportunity to understanding the multilevel correlates of non-adherence (patient, health care provider, transplant center, and healthcare system levels) independent from patients’ financial burden, currently understudied in KT.

*Methods: Applying a multi-staged sampling approach, we included 1,105 patients from 20 KT centers. Nonadherence to immunosuppressives (implementation phase) was defined as any deviation in taking or timing adherence and/or dose reduction assessed by the BAASIS©. Based on Bronfenbrenner’s ecological model, we analyzed multilevel factors through sequential logistic regression analysis.

*Results: Prevalence of immunosuppressive nonadherence was 39.7%. Factors associated with nonadherence were: at patient level – stable partner (OR:0.73; CI:0.565-0.95), taking immunosuppressives once a day (OR:2.57; CI:1.23-5.37), nonadherence to appointment keeping (OR:3.05; IC:2.07-4.48), nonadherence to physical activity recommendations (OR:1.82; CI:1.37-2.43); at transplant center level: centers of more than 500 beds (OR:0.62; CI:0.50-0.77), dissatisfaction with waiting room structure (OR:1.80; CI:1.38-2.33), consultation longer 30 minutes (OR:1.60; CI:1.19-2.14), patients’ perceived adequacy of consultation´s frequency (OR:0.64; CI:0.44-0.92).

*Conclusions: This is the first multicenter study to show multilevel correlates of nonadherence in KT patients. Multilevel strategies to tackle nonadherence should also address the post-transplant care.

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To cite this abstract in AMA style:

Sanders-Pinheiro H, Colugnati FA, Denhaerynck K, Marsicano EO, Medina JO, Geest SDe. Multilevel Correlates of Immunosuppressive Nonadherence in Kidney Transplant Patients – The Multicenter ADHERE BRAZIL Study [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/multilevel-correlates-of-immunosuppressive-nonadherence-in-kidney-transplant-patients-the-multicenter-adhere-brazil-study/. Accessed June 7, 2025.

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