Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2021 Sep;34(9):1703-1711.
doi: 10.1111/tri.13993.

Is simplification of immunosuppressive medication a way to promote medication adherence of kidney transplant recipients? Findings from a randomized controlled trial

Regina van Zanten  1 , Annelies de Weerd  1 , Michiel Betjes  1 , Marieken Boer-Verschragen  1 , Emma K Massey  1
Affiliations
Randomized Controlled Trial

Is simplification of immunosuppressive medication a way to promote medication adherence of kidney transplant recipients? Findings from a randomized controlled trial

Regina van Zanten et al. Transpl Int. 2021 Sep.

Abstract

After kidney transplantation, a strict immunosuppressive medication regimen is necessary for graft survival. However, nonadherence to medication has been shown to occur early after transplantation and to increase over time. Weaning the recipient off dual therapy onto monotherapy in order to reduce immunosuppressive burden may also be a way to promote adherence, although little is known about the impact of such a regimen on fear of rejection. We performed a cohort study on medication adherence and fear of rejection in a randomized, investigator-driven, open-label, single-centre pilot study. Recipients were randomized at 6-months post-transplant to either continue Tacrolimus and Mycophenolate mofetil (TAC/MMF) or to taper MMF at 6 months and discontinue MMF at 9 months (TAC monotherapy). Recipients completed questionnaires about medication adherence and fear of rejection at 6 and 12-months post-transplantation. Medication adherence was significantly higher in the TAC monotherapy group compared to dual TAC/MMF therapy group (χ2 (1) = 4.582; P = 0.032). We found no difference in fear of rejection between the two groups of recipients (P = 0.887). Simplification of the medication regimen is a potential tool for increasing adherence in clinical practice (Netherlands Trial Register - NL4672).

Keywords: fear about rejection; graft rejection; kidney transplantation; medication adherence; tacrolimus.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of this study.
Figure 2
Figure 2
Transition medication adherence in recipients on Tacrolimus and Mycophenolate mofetil – between 6 and 12 months after kidney transplantation.
Figure 3
Figure 3
Transition medication adherence in recipients on tacrolimus monotherapy – between 6 and 12 months after kidney transplantation.
See this image and copyright information in PMC

References

    1. Dew MA, Posluszny DM, DiMartini AF, Myaskovsky L, Steel JL, DeVito Dabbs AJ. Posttransplant medical adherence: what have we learned and can we do better? Curr Transplant Rep 2018; 5: 174. - PMC - PubMed
    1. Sabaté E. Adherence to Long‐Term Therapies: Evidence for Action. Geneva: World Health Organization, 2003.
    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. - PubMed
    1. Gokoel SRM, Gombert‐Handoko KB, Zwart TC, van der Boog PJM, Moes D, de Fijter JW. Medication non‐adherence after kidney transplantation: a critical appraisal and systematic review. Transplant Rev 2020; 34: 100511. - PubMed
    1. Nevins TE, Robiner WN, Thomas W. Predictive patterns of early medication adherence in renal transplantation. Transplantation 2014; 98: 878. - PMC - PubMed

Publication types