Immunosuppressant therapy adherence and graft failure among pediatric renal transplant recipients

M. A. Chisholm-Burns, C. A. Spivey, R. Rehfeld, M. Zawaideh, Denise Roe, Rainer W G Gruessner

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

The study objective was to determine the association between immunosuppressant therapy (IST) adherence and graft failure among pediatric renal transplant recipients (RTRs) using data reported in the United States Renal Data System (USRDS), which contains Medicare prescription claims. RTRs (≤18 years) who received their only transplant during 1995-2000, experienced graft survival more than 6 months posttransplant, had 36 months of USRDS data (or had data until graft failure or death), utilized Medicare IST coverage, and were prescribed cyclosporine/tacrolimus were included. IST adherence was measured by medication possession ratio (MPR). Cox proportional hazards analysis was used to assess the relationship between time to graft failure and continuous MPR. MPR quartiles were used to examine MPR as a categorical variable (Quartile 4 = adherent group, Quartiles 1-3 = nonadherent group). Kaplan-Meier estimates of time to graft failure were compared between adherent and nonadherent groups. 877 RTRs met inclusion criteria. Cox proportional hazards modeling suggested that greater adherence was significantly associated with longer time to graft failure (p = 0.009), after adjusting for relevant clinical factors. Kaplan-Meier analysis found a difference between adherent and nonadherent groups in graft survival by time (χ2 = 5.68, p = 0.017). Interventions promoting adherence should be implemented among pediatric RTRs and parents/guardians to optimize graft survival.

Original languageEnglish (US)
Pages (from-to)2497-2504
Number of pages8
JournalAmerican Journal of Transplantation
Volume9
Issue number11
DOIs
StatePublished - Nov 2009

Fingerprint

Immunosuppressive Agents
Pediatrics
Transplants
Kidney
Graft Survival
Kaplan-Meier Estimate
Medicare
Information Systems
Therapeutics
Tacrolimus
Cyclosporine
Prescriptions
Transplant Recipients
Parents

Keywords

  • Graft failure
  • Medication adherence
  • Pediatric renal transplant recipients
  • Renal transplant

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

Immunosuppressant therapy adherence and graft failure among pediatric renal transplant recipients. / Chisholm-Burns, M. A.; Spivey, C. A.; Rehfeld, R.; Zawaideh, M.; Roe, Denise; Gruessner, Rainer W G.

In: American Journal of Transplantation, Vol. 9, No. 11, 11.2009, p. 2497-2504.

Research output: Contribution to journalArticle

Chisholm-Burns, M. A. ; Spivey, C. A. ; Rehfeld, R. ; Zawaideh, M. ; Roe, Denise ; Gruessner, Rainer W G. / Immunosuppressant therapy adherence and graft failure among pediatric renal transplant recipients. In: American Journal of Transplantation. 2009 ; Vol. 9, No. 11. pp. 2497-2504.
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