Adherence to Immunosuppressive Medications in Kidney Transplant Patients at Three Centers in Khartoum State, Sudan: A Cross-sectional Hospital Study

Background: Graft survival post-kidney transplantation is of paramount importance to patients and nephrologists. Nonadherence to immunosuppressive therapy can be associated with deterioration of renal function and graft rejection. This study aimed to evaluate the adherence to immunosuppressive medications in kidney transplant patients at three centers in Khartoum, Sudan. Methods: In this descriptive cross-sectional hospital-based survey, 277 post-kidneytransplant patients were recruited. Data were collected using a questionnaire and analyzed using the SPSS v.23. Our scoring method was calculated based on Morisky Medication Adherence Scale (MMAS-8) related to immunosuppressive medications and was expressed as questions in the questionnaire; every correct answer was given one mark, then the marks were gathered and their summation was expressed. Results: Overall, 33% ,45%, and 22% of the studied participants reported high, medium, and low adherence, respectively. The major factor for nonadherence was forgetfulness affecting 36.1% of those who did not adhere. The cost of the immunosuppressive medications did not negatively affect any of the participants' adherence (100%). However, a significant association was seen between adherence and occupational status, duration of transplantation, shortage of immunosuppressants, recognizing the name of immunosuppressant, side effect, and forgetfulness (P-values = 0.002, 0.01, 0.006 , 0.000, 0.022, and 0.000, respectively). Logistic regression analysis showed a significant association with occupational status, side effects, and forgetfulness.

Pancreaticogastrostomy following pancreaticoduodenectomy

Fifteen patients underwent pancreaticoduodenectomy for carcinoma of the head of pancereas [6 cases], periampullary carcinoma [8 cases] and cholangiocarcinoma of the lower end of the common bile duct [1 case]. Restoration of continuity of gastrointestinal tract was achieved by pancreaticogastrostomy as an alternative to pancreaticojejunostomy. One patient [6.6%] developed pancreatic fistula. It closed spontaneously after one week. The procedure was found to be easy and safe and can be recommended as a straight forward method of reconstruction following pancreatico-duodenectomy

Percutaneous drainage of intra-abdominal abscesses

Twenty patients with intra abdominal abscesses were treated with percutaneous drainage using CT or ultrasonographic guidance. Abscesses were simple in 13 patients and multiloculated in 7 patients. The success rate was 100% [13 out of 13 patients] for simple abscess and 43% [3 out of 7 patients] for multiloculated abscess. The overall success rate was 80%. There were no deaths, and one patient developed empyema