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. 2025 Jul 24;11(8):e1813.
doi: 10.1097/TXD.0000000000001813. eCollection 2025 Aug.

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

Martina de Zwaan  1 , Mariel Nöhre  1 , Felix Klewitz  1 , Maximilian Bauer-Hohmann  1 , Charlotte Kuczyk  1 , Yesim Erim  2 , Lena Schiffer  3 , Deborah Meier  4 , Julia K Wolff  4   5 , Uwe Tegtbur  6 , Lars Pape  7 , Mario Schiffer  8
Affiliations

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

Martina de Zwaan et al. Transplant Direct. .

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.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

None
Graphical abstract
FIGURE 1.
FIGURE 1.
Estimated values of the log-transformed BAASIS total score over time, adjusted for all covariates. The regression analysis is depicted in Table 3. BAASIS, Basel Assessment of Adherence to Immunosuppressive Medication Scale.
FIGURE 2.
FIGURE 2.
Estimated values of the interaction plot between BAASIS total score over time and sex, adjusted for all covariates. The regression analysis is depicted in Table 5. BAASIS, Basel Assessment of Adherence to Immunosuppressive Medication Scale.
FIGURE 3.
FIGURE 3.
Estimated values of the Interaction plot between BAASIS total score over time and time since transplantation, adjusted for all covariates. The regression analysis is depicted in Table 6. BAASIS, Basel Assessment of Adherence to Immunosuppressive Medication Scale.
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