Adherence profiles in kidney transplant patients: Causes and consequences

• Published in: Patient education and counseling Vol. 103; no. 1; pp. 189 - 198
• Main Authors: Villeneuve, Claire, Rousseau, Annick, Rerolle, Jean-Phillipe, Couzi, Lionel, Kamar, Nassim, Essig, Marie, Etienne, Isabelle, Westeel, Pierre-Francois, Büchler, Mathias, Esposito, Laure, Thierry, Antoine, Marquet, Pierre, Monchaud, Caroline
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-01-2020; Elsevier
• Subjects: Adherence; Humans; Immunosuppressant; Immunosuppressive Agents; Kidney Transplantation; Life Sciences; Longitudinal Studies; Medication Adherence; Middle Aged; Quality of Life; Adherence; SD; Immunosuppressant; MMAS-4; MCS-SF36; PRO; C0; CHU Limoges; WHO; Kidney transplantation
• ISSN: 0738-3991; 1873-5134
• DOI: 10.1016/j.pec.2019.08.002

•Patients with poor adherence time-profiles can be detected early.•Poor adherence is associated with young age, altered mental quality of life and depressive symptoms.•Non-adherent patients display a shorter survival without rejection.•Therapeutic education including psychological and behavioural intervention should target patients with poor adherence.•Transplant patients care should be based on a holistic approach provided by multidisciplinary teams.
Objective: Adherence is a dynamic phenomenon and a critical determinant of transplant patients outcome. The objective of this longitudinal study was to explore adherence in kidney transplant patients followed-up for up to three years after transplantation.
Methods: Adherence was repeatedly estimated using the Morisky-Green-Levine 4-Item Medication Adherence Scale, in two successive cohorts of 345 (EPIGREN) and 367 (EPHEGREN) kidney transplant recipients. Mixed effect modeling with latent processes and latent classes was used to describe adherence time-profiles.
Results: Two latent classes were identified. The adherent class represented 85% of the patients. Patients of the poorer-adherence class displayed a lower adherence at one month (p<10−3), which worsened over time. Good adherence was associated with age >50 years, fewer depression episodes (5% vs. 13%, p = 0.001) and a better mental health component of quality of life (MCS-SF36 47 ± 11 vs. 41 ± 13, p = 0.015). Survival without acute rejection episodes was longer in the adherent class (p = 0.004).
Conclusions: The risk of poor adherence in renal transplant patients can be detected as early as one month post-transplantation, using appropriate and easy tools adapted to routine monitoring.
Practice Implications: An early focus on vulnerable patients should allow putting into place actions in order to reduce the risk of poor outcome related to poor adherence.