Nonadherence Post-kidney Transplant is Associated with Increased Immune Activation Detected by Peripheral Blood Gene Expression Assay

N. Singh¹, A. Palermini¹, M. S. Naseer¹, T. Le¹, S. Tandukar¹, D. Aultman², H. Shokouh-Amiri², G. Zibari²

¹Transplant, John C. McDonald Regional Transplant Center - Willis Knighton Health System, Shreveport, LA, ²Advanced Surgery, John C. McDonald Regional Transplant Center - Willis Knighton Health System, Shreveport, LA

Meeting: 2021 American Transplant Congress

Abstract number: 672

Keywords: Gene expression, Genomics, Kidney transplantation, Non-invasive diagnosis

Topic: Clinical Science » Biomarkers, Immune Assessment and Clinical Outcomes

Session Information

Session Name: Biomarkers, Immune Assessment and Clinical Outcomes

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: Nonadherence to immunosuppression medications is common post-transplantation. We hypothesize that nonadherence results in a heightened alloimmune response in kidney transplant recipients (KTRs) which in turn may lead to adverse graft outcomes post-transplant. AlloMap (CareDx®) is a non-invasive peripheral blood gene expression assay associated with genes involved in immune response. Our center has been using cell-free DNA (Allosure; CareDx®) and gene expression assay (AlloMap; CareDx®) for immune monitoring in KTRs enrolled in OKRA registry since Nov 2019.

*Methods: We assessed the stable KTRs in the outpatient transplant clinic for self-reported adherence using the Morisky Medication Adherence Scale (MMAS-8), a structured eight-question survey from Sep 15 to Nov 15, 2020. The baseline demographics, number of medications, eGFR, BK viremia, medication side effects, graft rejection, cell-free DNA (Allosure; CareDx®), and gene expression assay (AlloMap; CareDx®) were compared between the non-adherent and adherent patients.

*Results: There were no statistically significant differences in baseline demographics (age, gender, and race), BK viremia, time post-transplant, medication side effects, and eGFR at 1-year post-transplant in adherent and non-adherent patients. The non-adherent patients, as compared with adherent patients, were on a lower number of medications (9.26 ± 2.70 vs 11.39 ± 3.79, p = 0.02), had more graft rejection (17.39% vs 15.25%, p = 0.01), and depicted higher AlloMap values on immunosurveillance post-transplant (10.85 ± 2.03 vs 8.05 ± 3.49, p = 0.01) [Table 1].

Table 1: Results
	Non-adherent (MMAS-8 score ≤6), [n=23]	Adherent (MMAS-8 score ≥7), [n=59]	P-Value
MMAS-8 Score, mean ± SD	5.43 ± 0.79	7.51 ± 0.50	<0.01
Time Post-Transplant (Years), mean ± SD	4.01 ± 4.75	4.12 ± 7.34	0.95
Number of Medications, mean ± SD	9.26 ± 2.70	11.39 ± 3.79	0.02
eGFR (ml/min/1.73m2) at 1-Year Post-Transplant, mean ± SD	53.63 ± 14.25	61.12 ± 21.35	0.19
Graft Rejection, % [n]	17.39 [4]	15.25 [9]	0.01
AlloSure, mean ± SD	0.87 ± 1.18	0.46 ± 0.87	0.07
AlloMap, mean ± SD	10.85 ± 2.03	8.05 ± 3.49	0.01

*Conclusions: Nonadherence as measured by MMAS-8 is associated with increased immune activation and a higher risk of graft rejection in KTRs.

To cite this abstract in AMA style:

Singh N, Palermini A, Naseer MS, Le T, Tandukar S, Aultman D, Shokouh-Amiri H, Zibari G. Nonadherence Post-kidney Transplant is Associated with Increased Immune Activation Detected by Peripheral Blood Gene Expression Assay [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/nonadherence-post-kidney-transplant-is-associated-with-increased-immune-activation-detected-by-peripheral-blood-gene-expression-assay/. Accessed May 2, 2025.

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