Skip to main content
SpringerLink
Log in

Differences in medication adherence between preemptive and post-dialysis young kidney transplant recipients

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

The mechanisms underlying the superior graft survival associated with preemptive kidney transplantation, compared with transplantation following a period of dialysis, are unknown. We aimed to compare medication adherence between preemptively transplanted young kidney transplant recipients and those who received a transplant after an interval of dialysis.

Methods

This was a secondary analysis of the Teen Adherence in Kidney transplant Effectiveness of Intervention Trial (TAKE-IT), in which adherence was assessed with electronic monitoring over 15 months among 11–24-year-old transplant recipients. Adherence scores were calculated for each day as 0%, 50%, or 100% (intake of none, half, or all prescribed doses). We used ordinal logistic regression, with generalized estimating equations to account for repeated measures within each participant, to estimate the association between preemptive transplantation and adherence. The model was adjusted for sex, age at transplant, time since transplant, primary kidney disease, race, donor source, medication insurer, household income, and adherence intervention.

Results

There were 43 preemptive transplant recipients and 103 who had been treated with dialysis. The median adherence score was 85.1% (IQR 81.3–88.9) for those preemptively transplanted, and 80.0% (IQR 76.7–83.4) for those transplanted after dialysis. Preemptively transplanted recipients had significantly higher odds of adherence than those dialyzed before transplantation (adjusted OR 1.76 95% CI 1.21–2.55; p = 0.003).

Conclusions

Preemptively transplanted patients showed significantly better adherence than those treated with dialysis before transplantation. This suggests that the superior outcomes observed among preemptive kidney transplant recipients may reflect selection of patients more likely to adhere to therapy.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kasiske BL, Snyder JJ, Matas AJ, Ellison MD, Gill JS, Kausz AT (2002) Preemptive kidney transplantation: the advantage and the advantaged. J Am Soc Nephrol 13:1358–1364. https://doi.org/10.1097/01.ASN.0000013295.11876.C9

    Article  PubMed  Google Scholar 

  2. Prezelin-Reydit M, Combe C, Harambat J, Jacquelinet C, Merville P, Couzi L, Leffondre K (2019) Prolonged dialysis duration is associated with graft failure and mortality after kidney transplantation: results from the French transplant database. Nephrol Dial Transplant 34:538–545. https://doi.org/10.1093/ndt/gfy039

    Article  CAS  PubMed  Google Scholar 

  3. Amaral S, Sayed BA, Kutner N, Patzer RE (2016) Preemptive kidney transplantation is associated with survival benefits among pediatric patients with end-stage renal disease. Kidney Int 90:1100–1108. https://doi.org/10.1016/j.kint.2016.07.028

    Article  PubMed  PubMed Central  Google Scholar 

  4. Butani L, Perez R (2011) Effect of pretransplant dialysis modality and duration on long-term outcomes of children receiving renal transplants. Transplantation 91:447–451. https://doi.org/10.1097/TP.0b013e318204860b

    Article  PubMed  Google Scholar 

  5. Mange KC, Joffe MM, Feldman HI (2001) Effect of the use or nonuse of long-term dialysis on the subsequent survival of renal transplants from living donors. N Engl J Med 344:726–731. https://doi.org/10.1056/NEJM200103083441004

  6. Schold JD, Buccini LD, Goldfarb DA, Flechner SM, Poggio ED, Sehgal AR (2014) Association between kidney transplant center performance and the survival benefit of transplantation versus dialysis. Clin J Am Soc Nephrol 9:1773–1780. https://doi.org/10.2215/CJN.02380314

    Article  PubMed  PubMed Central  Google Scholar 

  7. Turenne MN, Port FK, Strawderman RL, Ettenger RB, Alexander SR, Lewy JE, Jones CA, Agodoa LY, Held PJ (1997) Growth rates in pediatric dialysis patients and renal transplant recipients. Am J Kidney Dis 30:193–203. https://doi.org/10.1016/s0272-6386(97)90052-4

    Article  CAS  PubMed  Google Scholar 

  8. Hobbs SA, Sexson SB (1993) Cognitive development and learning in the pediatric organ transplant recipient. J Learn Disabil 26:104–113. https://doi.org/10.1177/002221949302600203

    Article  CAS  PubMed  Google Scholar 

  9. Harciarek M, Biedunkiewicz B, Lichodziejewska-Niemierko M, Debska-Slizien A, Rutkowski B (2011) Continuous cognitive improvement 1 year following successful kidney transplant. Kidney Int 79:1353–1360. https://doi.org/10.1038/ki.2011.40

    Article  PubMed  Google Scholar 

  10. Haller MC, Kammer M, Oberbauer R (2019) Dialysis vintage and outcomes in renal transplantation. Nephrol Dial Transplant 34:555–560. https://doi.org/10.1093/ndt/gfy099

    Article  PubMed  Google Scholar 

  11. Gjertson DW, Cecka JM (2001) Determinants of long-term survival of pediatric kidney grafts reported to the United Network for Organ Sharing kidney transplant registry. Pediatr Transplant 5:5–15. https://doi.org/10.1034/j.1399-3046.2001.00137.x

    Article  CAS  PubMed  Google Scholar 

  12. Fennell RS, Tucker C, Pedersen T (2001) Demographic and medical predictors of medication compliance among ethnically different pediatric renal transplant patients. Pediatr Transplant 5:343–348. https://doi.org/10.1034/j.1399-3046.2001.00027.x

    Article  CAS  PubMed  Google Scholar 

  13. Gris J-C, Branger B, Vecina F, Al Sabadani B, Fourcade J, Schved JF (1994) Increased cardiovascular risk factors and features of endothelial activation and dysfunction in dialyzed uremic patients. Kidney Int 46:807–813. https://doi.org/10.1038/ki.1994.336

    Article  CAS  PubMed  Google Scholar 

  14. Meier-Kriesche H-U, Kaplan B (2002) Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes a paired donor kidney analysis. Transplantation 74:1377–1381. https://doi.org/10.1097/01.TP.0000034632.77029.91

    Article  PubMed  Google Scholar 

  15. Kennedy SE, Mackie FE, Rosenberg AR, McDonald SP (2006) Waiting time and outcome of kidney transplantation in adolescents. Transplantation 82:1046–1050. https://doi.org/10.1097/01.tp.0000236030.00461.f4

    Article  PubMed  Google Scholar 

  16. Patzer RE, Sayed BA, Kutner N, McClellan WM, Amaral S (2013) Racial and ethnic differences in pediatric access to preemptive kidney transplantation in the United States. Am J Transplant 13:1769–1781. https://doi.org/10.1002/ajt.12299

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Patzer RE, Amaral S, Klein M, Kutner N, Perryman JP, Gazmararian JA, McClellan WM (2012) Racial disparities in pediatric access to kidney transplantation: does socioeconomic status play a role? Am J Transplant 12:369–378. https://doi.org/10.1111/j.1600-6143.2011.03888.x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Atkinson MA, Roem JL, Gajjar A, Warady BA, Furth SL, Muñoz A (2020) Mode of initial renal replacement therapy and transplant outcomes in the chronic kidney disease in children (CKiD) study. Pediatr Nephrol 35:1015–1021. https://doi.org/10.1007/s00467-019-04416-2

    Article  PubMed  Google Scholar 

  19. Abramowicz D, Hazzan M, Maggiore U, Peruzzi L, Cochat P, Oberbauer R, Haller MC, Van Biesen W (2016) Does pre-emptive transplantation versus post start of dialysis transplantation with a kidney from a living donor improve outcomes after transplantation? A systematic literature review and position statement by the Descartes Working Group and ERBP. Nephrol Dial Transplant 31:691–697. https://doi.org/10.1093/ndt/gfv378

    Article  PubMed  Google Scholar 

  20. Foster BJ, Pai ALH, Zelikovsky N, Amaral S, Bell L, Dharnidharka VR, Hebert D, Holly C, Knauper B, Matsell D, Phan V, Rogers R, Smith JM (2018) A Randomized trial of a multicomponent intervention to promote medication adherence: the teen adherence in kidney transplant effectiveness of intervention trial (TAKE-IT). Am J Kidney Dis 72:30–41. https://doi.org/10.1053/j.ajkd.2017.12.012

    Article  PubMed  PubMed Central  Google Scholar 

  21. Altman DG, Bland JM (2011) Statistics notes: how to obtain the P value from a confidence interval. BMJ 343

    Article  PubMed  Google Scholar 

  22. Warady BA, Hébert D, Kenneth Sullivan E, Alexander SR, Tejani A (1997) Renal transplantation, chronic dialysis, and chronic renal insufficiency in children and adolescents. The 1995 Annual Report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol 11:49–64. https://doi.org/10.1007/s004670050232

    Article  CAS  PubMed  Google Scholar 

  23. Scornik JC, Bromberg JS, Norman DJ, Bhanderi M, Gitlin M, Petersen J (2013) An update on the impact of pre-transplant transfusions and allosensitization on time to renal transplant and on allograft survival. BMC Nephrol 14:217. https://doi.org/10.1186/1471-2369-14-217

    Article  PubMed  PubMed Central  Google Scholar 

  24. Wiebe C, Nevins TE, Robiner WN, Thomas W, Matas AJ, Nickerson PW (2015) The synergistic effect of class II HLA epitope-mismatch and nonadherence on acute rejection and graft survival. Am J Transplant 15:2197–2202. https://doi.org/10.1111/ajt.13341

    Article  CAS  PubMed  Google Scholar 

  25. Griffin KJ, Elkin TD (2001) Non-adherence in pediatric transplantation: a review of the existing literature. Pediatr Transplant 5:246–249. https://doi.org/10.1034/j.1399-3046.2001.005004246.x

    Article  CAS  PubMed  Google Scholar 

  26. de Geest S, Burkhalter H, Bogert L, Berben L, Glass TR, Denhaerynck K (2014) Describing the evolution of medication nonadherence from pretransplant until 3 years post-transplant and determining pretransplant medication nonadherence as risk factor for post-transplant nonadherence to immunosuppressives: The Swiss Transplant Cohort Study. Transpl Int 27:657–666. https://doi.org/10.1111/tri.12312

    Article  PubMed  Google Scholar 

  27. Chadban SJ, Ahn C, Axelrod DA, Foster BJ, Kasiske BL, Kher V, Kumar D, Oberbauer R, Pascual J, Pilmore HL, Rodrigue JR, Segev DL, Sheerin NS, Tinckam KJ, Wong G, Knoll GA (2020) KDIGO clinical practice guideline on the evaluation and management of candidates for kidney transplantation. Transplantation 104:S11–S103. https://doi.org/10.1097/TP.0000000000003136

    Article  PubMed  Google Scholar 

  28. Wightman A, Taylor Zimmerman C, Neul S, Lepere K, Cedars K, Opel D (2019) Caregiver experience in pediatric dialysis. Pediatrics 143

    Article  PubMed  Google Scholar 

  29. Wightman A (2020) Caregiver burden in pediatric dialysis. Pediatr Nephrol 35:1575–1583. https://doi.org/10.1007/s00467-019-04332-5

    Article  PubMed  Google Scholar 

  30. Franco A, Más-Serrano P, González Y, Balibrea N, Rodríguez D, López MI, Pérez Contreras FJ (2020) Pre-emptive deceased-donor kidney transplant: a matched cohort study. Nefrologia (Engl Ed) 40:32–37. https://doi.org/10.1016/j.nefro.2019.04.010

    Article  PubMed  Google Scholar 

  31. Dobbels F, Hames A, Aujoulat I, Heaton N, Samyn M (2012) Should we retransplant a patient who is non-adherent? A literature review and critical reflection. Pediatr Transplant 16:4–11. https://doi.org/10.1111/j.1399-3046.2011.01633.x

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the study coaches and patients and families who participated in the study.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Montreal Children’s Hospital, McGill University, 1001 Bd Décarie, QC, H4A 2L1, Montréal, Canada

    Yulia Vaisbourd & Bethany J. Foster

  2. Research Institute of The McGill University Health Centre, Montreal, QC, Canada

    Mourad Dahhou, Xun Zhang & Bethany J. Foster

  3. Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada

    Alexia De Simone & Bethany J. Foster

Authors
  1. Yulia Vaisbourd
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mourad Dahhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexia De Simone
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xun Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bethany J. Foster
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yulia Vaisbourd.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Below is the link to the electronic supplementary material.

Graphical Abstract (PPTX 484 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vaisbourd, Y., Dahhou, M., De Simone, A. et al. Differences in medication adherence between preemptive and post-dialysis young kidney transplant recipients. Pediatr Nephrol 38, 1949–1956 (2023). https://doi.org/10.1007/s00467-022-05797-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-022-05797-7

Keywords

Search

Navigation