BACKGROUND: Nonadherence (NA) is a known cause of acute rejection (AR) and graft loss in this modern era of immunosuppression. However, extent of contribution of various factors (psychosocial (PSY), economic (ECO) etc.) is not conclusively established.
METHODS: In this retrospective analysis, we studied NA in 15 (9.7%) patients who developed AR in a cohort of 154 kidney alone transplants performed consecutively on 152 adult patients at our center between 1/1/2009 and 7/31/2012 (2 patients in the cohort were retransplanted because they lost their first graft within a week due to vascular event) and followed for a median period of 19.5 ±12.0 (range 3.1-46.4) months. All the recipients had thorough PSY evaluation by a social worker followed by further evaluation, if deemed necessary, by a psychiatrist experienced in the management of transplant issues before wait-listing. It was also ascertained that, before wait-listing and after transplant, all the recipients had adequate ECO support for immunosuppression and detailed education. All AR patients were analyzed for demographics, patient survival (PS), graft survival (GS), antibody-mediated rejection (AMR), and cell-mediated rejection (ACR). They were also reevaluated for their PSY and ECO status.
RESULTS: Overall, PS, GS and death-censored GS were 97.4%, 93.5%, and 96.1% respectively. In AR patients, PS and GS were 100% and 80% respectively. Six of 15 (40%) AR patients had AMR and ACR, and the remaining 9 (60%) had only ACR. Seven of 15 (46.7%) patients with AR had definite evidence of NA (admission of NA and/or low levels of tacrolimus twice or more); one of 7 (14.3%) lost the graft. Six of 7 patients had adequate ECO support; however, each of them was found to have some PSY issues. There were no significant PSY or ECO issues in adherent AR patients. There was no significant difference in demographics and measured outcomes between NA and adherent patients with AR.
|Variable||NA Patients (n=7)||A Patients (n=8)|
|Age in years, median±SD (range)||43.5±13.8 (23.2-64.0)||50.3±14.9 (29.7-72.8)|
CONCLUSION: PSY issues are the predominant contributors to NA leading to AR during early post transplant period. This complex frontier needs to be investigated further.
To cite this abstract in AMA style:Govani M, Sheikh S, Decarlo-Frepan A, Rader T, Wee A, Ghoneim I, Wood S. Nonadherence Related to Psychosocial Issues Predominates in the Majority of Acute Rejections during Early Posttransplant Period [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/nonadherence-related-to-psychosocial-issues-predominates-in-the-majority-of-acute-rejections-during-early-posttransplant-period/. Accessed December 6, 2023.
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