While many clinical reports exclude mention of patient noncompliance, our experience includes those who often stop and then restart or even completely stop taking their immunosuppressive medications. We suspected graft failure due to noncompliance(GFNC) to be a major cause of late graft loss, particularly among younger transplant recipients. Using our prospectively followed cohort of 628 adult, primary kidney-alone transplant recipients, which comprised all participants in 5 randomized immunosuppression trials performed at our center since May, 2000, GFNC and other graft loss causes were determined prospectively from our ongoing clinical evaluation of each patients post-transplant follow-up. Using competing risks methodology, we determined the overall percentage of patients developing GFNC (and other graft loss causes), the significant prognostic factors for this hazard rate and its cumulative incidence (via Cox regression), and how graft survival would improve in the hypothetical situation of GFNC being eliminated. Cumulative incidence estimates of GFNC(N=29), GF-with-compliance(N=46), receiving a never functioning graft(N=7), and death with a functioning graft(N=53) at 101 months post-transplant (last observed graft loss) were: 9.8%, 10.9%, 1.1%, and 13.0%, respectively. Only 3 patients experienced GFNC during the first 24 months; GFNC represented 48.1%(26/54) of death-censored GFs beyond 24 months post-transplant. The same two variables were jointly associated with a significantly higher GFNC hazard and cumulative incidence: Younger Recipient Age (P<.000001 each) and Non-Caucasian Recipient (P=.004 and .02). Among 79 Non-Caucasians<35yr, 52%(15/29) of graft losses were due to noncompliance, and the estimated percentage of ever developing GFNC was 28.4%. Conversely, 0.0%(0/144) of Caucasians>50yr experienced GFNC. Finally, in the hypothetical absence of GFNC, estimated long-term graft survival dramatically improves for Non-Caucasians<35yr, increasing by 24.2%, from 47.4% to 71.9%. In conclusion, GFNC is a major cause of late GF, representing close to 50% of all late death-censored graft failures. Younger recipient age and being Non-Caucasian were highly associated with greater risk of GFNC. Interventional approaches to eliminate GFNC could dramatically improve long-term kidney graft survival in these patient subgroups.
To cite this abstract in AMA style:Gaynor J, Ciancio G, Guerra G, Sageshima J, Hanson L, Roth D, Chen L, Kupin W, Mattiazzi A, Tueros L, Flores S, Aminsharifi J, Joshi S, Chediak Z, Ruiz P, III GBurke. Noncompliance as a Major Cause of Late Graft Failure in Kidney Transplantation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/noncompliance-as-a-major-cause-of-late-graft-failure-in-kidney-transplantation/. Accessed December 4, 2020.
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