Nonadherence (NA) is likely the primary driver of late graft loss and was found to occur in 59% of renal transplant (RTx) patients at our center. PreRTx adherence tools (i.e. scorecards) were developed to provide a standard method to identify those at significant risk of NA post RTx. 3 versions were created containing criteria specific to candidate type: preemptive (PE), hemodialysis (HD) and peritoneal dialysis (PD). We sought to determine NA frequency and identify strategies for postRTx interventions in those identified as NA.

A retrospective review for RTx candidates evaluated by the social worker scorecards was performed. Scorecard and psychosocial data were used to assign candidates to an adherence risk category including: excellent, good, conditional, high risk and poor with each category providing a recommendation on evaluation progression (table 1). Quantity of scorecards administered and risk category percentages were calculated and differences analyzed via chi square testing.

326 scorecards were completed Jan-Sept 2015. Although 82% could continue with evaluation, only 5% were deemed excellent; 14% deferred and 4% poor. PD had the highest excellent and good (65%) scores followed by HD (53%) and PE (50%). Greatest risk of NA (high risk and poor) occurred in HD (21%) followed by PE (13%) and PD (4%). Most common reasons for conditional acceptance were lack of support and uncontrolled medical condition which were more highly associated with PE (37%). No significant differences between risk categories were identified amongst patient populations.

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Analysis of adherence scorecards administered as part of the RTx evaluation reveals a similar proportion of patients in PE, HD and PD groups. This tool allows standardization and provides an objective measure of pre RTx adherence. Despite being the largest cohort of potential candidates, HD patients have the greatest risk of NA and may require adherence interventions. Future directions include implementing targeted interventions and assessment of postRTx outcomes per risk category.

CITATION INFORMATION: Kaiser T, Daley K, Dick L, Deye L, Parrish N, Huff J, Govil A, Abu Jawdeh B, Mogilishetty G, Alloway R, Woodle E. Tool to Assess Risk of Non-Adherence in Renal Transplant Candidates. Am J Transplant. 2016;16 (suppl 3).

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