• Mahmoud Mohamed, Karim Soliman, Raghavesh Pullalarevu, Mahmoud Kamel, Titte Srinivas, David Taber, and Posadas SalasMaria AuroraMADivision of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. Electronic address: posadas@musc.edu..
• Division of Nephrology, Department of Medicine, University of Tennessee, Memphis, TN, USA.
• Am. J. Med. Sci. 2021 Oct 1; 362 (4): 381-386.

BackgroundNon-adherence is an important aspect of transplantation that affect outcomes. This study aims to investigate the impact of non-adherence to laboratory and clinic appointments on medication non-adherence and outcomes in kidney transplant (KT) recipients.MethodsWe analyzed KT recipients between 2005-14 with a detailed review of the medical records for non-adherence to laboratory and clinic appointments, as well as medication regimens. Baseline characteristics and clinical outcomes were compared between adherent and non-adherent groups.ResultsA total of 1413 KT recipients were included: 754 who were adherent and 659 who were non-adherent. Non-adherent recipients tend to be younger, African American, and have private insurance. Adherent patients tend to have a history of DM, heart disease, and receive an ECD kidney. Non-adherence to appointments was a strong predictor of medication non-adherence (OR 3.1), acute rejection (OR 1.4), and subsequent rejection episodes (OR 3.3 and 8.1 respectively for ≥ 1 and ≥ 2 rejection episodes). Subset analysis of patients who had early non-adherence within 1-year post-transplant showed predominance of younger, African American patients. The same patients had higher prevalence of medication non-compliance, overall and ≥ 1-year post-transplant, and mean number of readmissions. Kaplan-Meier analysis showed a trend towards lower graft survival in this group.ConclusionsEarly non-adherence to laboratory and clinic appointments is a strong predictor of late medication non-adherence, acute rejection, and graft loss. Targeting patients that demonstrate early non-adherence to appointments with focused interventions may help improve kidney transplant outcomes in this high risk group.Copyright © 2021 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

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