Associations of characteristics of renal transplant recipients with clinicians' perceptions of adherence to immunosuppressant therapy

Background. The objective of the study was to determine surveillance criteria for renal transplant recipients (RTRs) at highest risk for immunosuppressant therapy nonadherence. Methods. Retrospective analyses were performed on follow-up data in the United States Renal Data System. Those who received transplants between January 1, 1995 and December 31, 2002, had at least 36 months of follow-up data, and did not receive a second renal transplant were included in the analyses. The risk of nonadherence was estimated by random effects logistic regression while controlling for age, gender, race, education, donor type, primary insurance, time since transplant, and immunosuppressant medications using the STATA software (College Station, TX). Association between nonadherence and graft failure was also examined. Results. A total of 53,997 individuals met the inclusion criteria. About 6% of RTRs were reported nonadherent. Nonadherence risk increased with time posttransplant and decreased with age (P<0.001). RTRs who were male, nonwhite, or used mycophenolate mofetil or tacrolimus were more likely to be nonadherent with odds ratios (OR) of 1.36, 1.99, 1.13, and 1.31, respectively (P<0.05) than RTRs who used cyclosporine, steroids, azathioprine, or had Medicare (P<0.05). Nonadherent RTRs were more likely to experienced graft failure (P<0.001). Conclusions. Interventions to improve adherence should target younger RTRs, male RTRs, nonwhite RTRs, and those not on Medicare to reduce risk of graft failure.