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Multicenter Study
. 2021 Jan 1;105(1):255-266.
doi: 10.1097/TP.0000000000003214.

Multilevel Correlates of Immunosuppressive Nonadherence in Kidney Transplant Patients: The Multicenter ADHERE BRAZIL Study

Helady Sanders-Pinheiro  1 , Fernando A B Colugnati  1 , Kris Denhaerynck  2 , Elisa O Marsicano  1 , José O P Medina  3 , Sabina De Geest  2   4 ; ADHERE BRAZIL Study Team; ADHERE BRAZIL study team includes the following individuals
Collaborators, Affiliations
Multicenter Study

Multilevel Correlates of Immunosuppressive Nonadherence in Kidney Transplant Patients: The Multicenter ADHERE BRAZIL Study

Helady Sanders-Pinheiro et al. Transplantation. .

Abstract

Background: Immunosuppressive nonadherence is a risk factor for worse outcomes after kidney transplantation (KT). Brazil, having the world's largest public, fully covered transplantation system and the second-highest KT volume worldwide, provides a unique setting for studying multilevel correlates of nonadherence (patient, healthcare provider, transplant center, and healthcare system levels) independent of patients' financial burden.

Methods: By applying a multistage sampling approach, we included 1105 patients from 20 KT centers. Nonadherence to immunosuppressives (implementation phase) was defined as any deviation in taking or timing adherence and dose reduction assessed by the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Based on Bronfenbrenner's ecological model, we assessed multilevel factors using established instruments and measures specifically developed for this study and analyzed their independent contribution to nonadherence by performing sequential logistic regression analysis.

Results: The nonadherence prevalence rate was 39.7%. The following factors were independently associated with nonadherence: Patient level-having a stable partner (odds ratio [OR]: 0.75; confidence interval [CI]: 0.58-0.97), nonadherence to appointments (OR: 2.98; CI: 2.03-4.39), and nonadherence to physical activity recommendations (OR: 1.84; CI: 1.38-2.46); and transplant center level-satisfaction with the waiting room structure (OR: 0.54; CI: 0.42-0.71), consultation >30 minutes (OR: 1.60; CI: 1.19-2.14), adequacy of the consultation frequency (OR: 0.62; CI: 0.43-0.90), and centers with >500 beds (OR: 0.58; CI: 0.46-0.73).

Conclusions: As the first multicenter study assessing multilevel correlates of nonadherence in KT, our findings point to the need for multilevel interventions beyond the patient level, targeting transplant center practice patterns as an approach to tackle nonadherence.

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Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Dew MA, DiMartini AF, De Vito Dabbs A, et al. Rates and risk factors for nonadherence to the medical regimen after adult solid organ transplantation. Transplantation. 2007;83:858–873.
    1. Pinsky BW, Takemoto SK, Lentine KL, et al. Transplant outcomes and economic costs associated with patient noncompliance to immunosuppression. Am J Transplant. 2009;9:2597–2606.
    1. De Geest S, Denhaerynck K, Dobbels F. Grinyó J, ed. Clinical and economic consequences of non-adherence to immunosuppressive drugs in adult solid organ transplantation. Compliance in solid organ transplantation. In: International Transplantation Updates. 2011. Barcelona, Spain: Permanyer Publications; 63–81.
    1. Nevins TE, Nickerson PW, Dew MA. Understanding medication nonadherence after kidney transplant. J Am Soc Nephrol. 2017;28:2290–2301.
    1. Prendergast MB, Gaston RS. Optimizing medication adherence: an ongoing opportunity to improve outcomes after kidney transplantation. Clin J Am Soc Nephrol. 2010;5:1305–1311.

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