Longitudinal Course and Baseline Predictors of Trajectories of Clinician-assessed Adherence to Immunosuppressant Medication in Patients after Kidney Transplantation: A KTx360° Substudy.

Abstract

Background: Optimal and maintained adherence to immunosuppressive medication is essential to kidney graft success.

Methods: We analyzed the longitudinal course of immunosuppressant adherence as measured with the Basel Assessment of Adherence to Immunosuppressive Medication Scale interview for up to 3-y duration of the Kidney Transplantation 360° study. Additionally, we examined putative baseline predictors of adherence trajectories. During the investigation period, patients participated in a multidisciplinary aftercare program consisting of case management, psychosocial and exercise assessments and interventions, including telemedicine support.

Results: The analysis sample with at least 1 valid information on the Basel Assessment of Adherence to Immunosuppressive Medication Scale consisted of 838 adult patients (41.3% women) aged 52.3 y (SD 13.5). Adherence to immunosuppressants improved significantly during the Kidney Transplantation 360° aftercare program; however, at each assessment point, 17%-25% of the patients still reported suboptimal adherence. Baseline predictors for a better improvement of adherence were younger age, male sex, and a longer duration since transplantation. Those variables were associated with a lower adherence at baseline, and we detected a "catch-up effect" over time, which might have been supported by the comprehensive aftercare program.

Conclusions: We believe that our aftercare program has supported the "catch-up effect" in adherence in younger male patients with a longer time after transplantation. However, the lack of a control group limits causal interpretations.