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Prospective Measures of Adherence by Questionnaire, Low Immunosuppression and Graft Outcome in Kidney Transplantation.

Authors :
Prezelin-Reydit M
Dubois V
Caillard S
Parissiadis A
Etienne I
Hau F
Albano L
Pourtein M
Barrou B
Taupin JL
Mariat C
Absi L
Vigneau C
Renac V
Guidicelli G
Visentin J
Merville P
Thaunat O
Couzi L
Source :
Journal of clinical medicine [J Clin Med] 2021 May 10; Vol. 10 (9). Date of Electronic Publication: 2021 May 10.
Publication Year :
2021

Abstract

Background: Non-adherence with immunosuppressant medication (MNA) fosters development of de novo donor-specific antibodies ( dn DSA), rejection, and graft failure (GF) in kidney transplant recipients (KTRs). However, there is no simple tool to assess MNA, prospectively. The goal was to monitor MNA and analyze its predictive value for dn DSA generation, acute rejection and GF.<br />Methods: We enrolled 301 KTRs in a multicentric French study. MNA was assessed prospectively at 3, 6, 12, and 24 months (M) post-KT, using the Morisky scale. We investigated the association between MNA and occurrence of dn DSA at year 2 post transplantation, using logistic regression models and the association between MNA and rejection or graft failure, using Cox multivariable models.<br />Results: The initial percentage of MNA patients was 17.7%, increasing to 34.6% at 24 months. Nineteen patients (8.4%) developed dn DSA 2 to 3 years after KT. After adjustment for recipient age, HLA sensitization, HLA mismatches, and maintenance treatment, MNA was associated neither with dn DSA occurrence, nor acute rejection. Only cyclosporine use and calcineurin inhibitor (CNI) withdrawal were strongly associated with dn DSA and rejection. With a median follow-up of 8.9 years, GF occurred in 87 patients (29.0%). After adjustment for recipient and donor age, CNI trough level, dn DSA, and rejection, MNA was not associated with GF. The only parameters associated with GF were dn DSA occurrence, and acute rejection.<br />Conclusions: Prospective serial monitoring of MNA using the Morisky scale does not predict dn DSA occurrence, rejection or GF in KTRs. In contrast, cyclosporine and CNI withdrawal induce dnDSA and rejection, which lead to GF.

Details

Language :
English
ISSN :
2077-0383
Volume :
10
Issue :
9
Database :
MEDLINE
Journal :
Journal of clinical medicine
Publication Type :
Academic Journal
Accession number :
34068497
Full Text :
https://doi.org/10.3390/jcm10092032