Session Name: Biomarkers, Immune Assessment and Clinical Outcomes
Session Date & Time: None. Available on demand.
*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].
|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 ||15.25 ||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 September 22, 2021.
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