Psychosocial Variables Associated with Immunosuppressive Medication Non-Adherence after Renal Transplantation.

INTRODUCTION: Non-adherence to immunosuppressive medication is regarded as an important factor for graft rejection and loss after successful renal transplantation. Yet, results on prevalence and relationship with psychosocial parameters are heterogeneous. The main aim of this study was to investigate the association of immunosuppressive medication non-adherence and psychosocial factors. METHODS: In 330 adult renal transplant recipients (≥12 months posttransplantation), health-related quality of life, depression, anxiety, social support, and subjective medication experiences were assessed, and their associations with patient-reported non-adherence was evaluated. RESULTS: 33.6% of the patients admitted to be partially non-adherent. Non-adherence was associated with younger age, poorer social support, lower mental, but higher physical health-related quality of life. There was no association with depression and anxiety. However, high proportions of clinically relevant depression and anxiety symptoms were apparent in both adherent and non-adherent patients. CONCLUSION: In the posttransplant follow-up, kidney recipients with lower perceived social support, lower mental and higher physical health-related quality of life, and younger age can be regarded as a risk group for immunosuppressive medication non-adherence. In follow-up contacts with kidney transplant patients, physicians may pay attention to these factors. Furthermore, psychosocial interventions to optimize immunosuppressive medication adherence can be designed on the basis of this information, especially including subjectively perceived physical health-related quality of life and fostering social support seems to be of importance.

Up to a Third of Renal Transplant Recipients Have Deficiencies in Cognitive Functioning.

INTRODUCTION: Kidney transplantation is beneficial in improving cognitive abilities in patients with chronic kidney disease; however, there is still uncertainty concerning which cognitive domains benefit and to what extent. AIM: In the present study, cognitive functioning of renal transplant recipients was compared to normative data. Sociodemographic and clinical parameters that were associated with low cognitive performance were identified. DESIGN: A total of 109 renal transplant recipients (63% men) participated in the study, with a mean age of 51.8 (standard deviation [SD] = 14.2) years. The cognitive test battery consisted of measurements assessing memory, attention, executive function, reproductive, and deductive ability. RESULTS: In all tests, participants showed mean scores ranging within 1 SD of the population means. However, except for tests measuring memory, the percentage of participants scoring more than 1 SD below normed means was higher than expected in a normal distribution of performance. In certain tests, up to a third of the participants scored below average. Participants with continuous low performance (11%) showed higher age, poorer education, a longer time since transplantation, higher serum levels of urea and creatinine, and were more likely to have a deceased donor allograft. DISCUSSION: Altough cognitive performance in renal transplant recipients matches normative data and confirms former findings, the amount of patients scoring more than 1 SD below average suggests that there are a considerable number of patients whose cognitive performance in certain domains lies below those of the general population. The identified sociodemographic and biochemical factors might be helpful to identify renal transplant recipients at risk.

Patient-reported non-adherence and immunosuppressant trough levels are associated with rejection after renal transplantation.

BACKGROUND: Different measures of non-adherence to immunosuppressant (IS) medication have been found to be associated with rejection episodes after successful transplantation. The aim of the current study was to investigate whether graft rejection after renal transplantation is associated with patient-reported IS medication non-adherence and IS trough level variables (IS trough level variability and percentage of sub-therapeutic IS trough levels). METHODS: Patient-reported non-adherence, IS trough level variability, percentage of sub-therapeutic IS trough levels, and acute biopsy-proven late allograft rejections were assessed in 267 adult renal transplant recipients who were ≥12 months post-transplantation. RESULTS: The rate of rejection was 13.5%. IS trough level variability, percentage of sub-therapeutic IS trough levels as well as patient-reported non-adherence were all significantly and positively associated with rejection, but not with each other. Logistic regression analyses revealed that only the percentage of sub-therapeutic IS trough levels and age at transplantation remained significantly associated with rejection. CONCLUSIONS: Particularly, the percentage of sub-therapeutic IS trough levels is associated with acute rejections after kidney transplantation whereas IS trough level variability and patient-reported non-adherence seem to be of subordinate importance. Patient-reported non-adherence and IS trough level variables were not correlated; thus, non-adherence should always be measured in a multi-methodological approach. Further research concerning the best combination of non-adherence measures is needed.