Logo image
Back
Patient Identified Medication Adherence Barriers Predict Acute Rejection in Kidney Transplant Patients: An Improving Renal Outcomes Collaborative Study
Abstract   Open access   Peer reviewed

Patient Identified Medication Adherence Barriers Predict Acute Rejection in Kidney Transplant Patients: An Improving Renal Outcomes Collaborative Study

C.M. Hite, C. Mara, S. Ranabothu, M. Yanik, J. Vansickle, M.E. Seifert, P. Singer, C. Belsha, L. Harshman, J. Parsons, …
American journal of transplantation, Vol.26(7 Supplement 1), pp.S455-S456
06/2026
DOI: 10.1016/j.ajt.2026.05.893
url
https://doi.org/10.1016/j.ajt.2026.05.893View
Published (Version of record) Open Access

Abstract

Purpose: To determine the prevalence of patient-identified medication adherence barriers (PMAB) among kidney transplant recipients at nine children’s hospitals and evaluate the association between PMAB and subsequent biopsy-proven acute T-cell-mediated rejection (BP-aTCMR). Methods: This retrospective cohort study using the Improving Renal Outcomes Collaborative (IROC) database identified 900 kidney transplant recipients and/or caregivers who completed an initial adherence barriers assessment tool (BAT) and subsequently evaluated them for BP-aTCMR in the 12 months after BAT administration. BP-aTCMR was diagnosed by Banff criteria and included borderline TCMR and higher. The proportion of BP-aTCMR in those with and without PMAB was compared by chi-squared analysis. A mixed-effects logistic regression model adjusting for prior BP-aTCMR, age at transplant, age at assessment, race, donor type, HLA mismatch, gender, previous transplant, and site-level variation was used to examine the association between PMAB and BP-aTCMR. Results: Overall, 389 (43.2%) patients and/or their caregivers reported ≥1 PMAB. Biopsy rates did not differ by PMAB status. Patients were more likely than caregivers to identify a PMAB (p<0.001). Borderline or higher BP-aTCMR occurred in 17.5% of those with ≥1 PMAB compared to 12.5% of those without PMAB (p = 0.04). Among those with BP-aTCMR, having ≥1 PMAB was associated with a nonsignificant trend toward more severe rejection (Banff ≥1B) (28/68 [41.2%] vs 19/64 [29.7%], p=0.17). In multivariable analysis, presence of ≥1 PMAB was associated with higher odds of TCMR (OR=1.72, 95% CI 1.14-2.59, p=0.01). Prior TCMR (OR=2.23, p=0.001), older age at transplant (OR=1.19/year, p<0.001), and younger age at assessment (OR=0.84/year, p<0.001) were also significant predictors. No other covariates were significant. Site-level variance accounted for ∼6-7% of variability in outcomes. Conclusions: In children, adolescents, and young adults with a kidney transplant, identification of medication adherence barriers was associated with a 72% higher odds of biopsy-proven T-cell mediated rejection within 12 months. This gives providers greater insight into rejection risk and an opportunity to improve address adherence barriers proactively to reduce this risk.

Details

Metrics

1 Record Views
Logo image