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Prospective Study on Late Consequences of Subclinical Non‐Compliance with Immunosuppressive Therapy in Renal Transplant Patients
Author(s) -
Vlaminck Hans,
Maes Bart,
Evers Georges,
Verbeke Geert,
Lerut Evelyne,
Van Damme Boudewijn,
Vanrenterghem Yves
Publication year - 2004
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2004.00537.x
Subject(s) - medicine , subclinical infection , creatinine , transplantation , incidence (geometry) , proportional hazards model , immunosuppression , renal function , renal transplant , prospective cohort study , kidney transplantation , physics , optics
In this prospective study we compared the incidence of late acute rejections (LAR) and changes in serum‐creatinine over time between compliers and noncompliers with immunosuppressive therapy more than 1 year post transplantation and explored the relative contribution of non‐compliance and other risk factors in the occurrence of LAR.One hundred and forty‐six adult renal transplant recipients were followed during a 5‐year period. Patients were interviewed at the beginning of the study and categorized as non‐compliers if they admitted to have skipped immunosuppressive medication on a regular basis during the previous 12 months. The occurrence of LAR during the follow‐up period was recorded.We identified 22.6% non‐compliers of which 21.2% experienced a late acute rejection compared with 8% in the group of compliers at 5 years postinclusion (p < 0.05). Kaplan‐Meier survival analysis showed a decreased rejection free time in non‐compliers compared with compliers (p = 0.03). Non‐compliant patients had a 3.2 higher risk of LAR (Cox regression analysis, p = 0.005). Non‐compliers experienced a higher increase in serum‐creatinine over time (Linear Mixed Models, p < 0.001).Non‐compliance in renal transplant patients more than 1‐year post transplantation is associated with an increased risk for LAR and a higher increase in serum‐creatinine during the following 5 years.