Frequency and impact of nonadherence to immunosuppressants after renal transplantation: a systematic review
Frequency and impact of nonadherence to immunosuppressants after renal transplantation: a systematic review
Nonadherence to immunosuppressants is recognized to occur after renal transplantation, but the size of its impact on transplant survival is not known. A systematic literature search identified 325 studies (in 324 articles) published from 1980 to 2001 reporting the frequency and impact of nonadherence in adult renal transplant recipients. Thirty-six studies meeting the inclusion criteria for further review were grouped into cross-sectional and cohort studies and case series. Meta-analysis was used to estimate the size of the impact of nonadherence on graft failure. Only two studies measured adherence using electronic monitoring, which is currently thought to be the most accurate measure. Cross-sectional studies (n=15) tended to rely on self-report questionnaires, but these were poorly described; a median (interquartile range) of 22% (18%-26%) of recipients were nonadherent. Cohort studies (n=10) indicated that nonadherence contributes substantially to graft loss; a median (interquartile range) of 36% (14%-65%) of graft losses were associated with prior nonadherence. Meta-analysis of these studies showed that the odds of graft failure increased sevenfold (95% confidence interval, 4%-12%) in nonadherent subjects compared with adherent subjects. Standardized methods of assessing adherence in clinical populations need to be developed, and future studies should attempt to identify the level of adherence that increases the risk of graft failure. However, this review shows nonadherence to be common and to have a large impact on transplant survival. Therefore, significant improvements in graft survival could be expected from effective interventions to improve adherence.
769-776
Butler, Janet A.
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Roderick, Paul
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Mullee, Mark
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Mason, Juan C.
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Peveler, Robert C.
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15 March 2004
Butler, Janet A.
2ae17543-2122-4649-a981-dfbadc5946f6
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Mullee, Mark
fd3f91c3-5e95-4f56-8d73-260824eeb362
Mason, Juan C.
51b973a9-834b-4008-b2b1-6f6139952e9f
Peveler, Robert C.
93198224-78d9-4c1f-9c07-fdecfa69cf96
Butler, Janet A., Roderick, Paul, Mullee, Mark, Mason, Juan C. and Peveler, Robert C.
(2004)
Frequency and impact of nonadherence to immunosuppressants after renal transplantation: a systematic review.
Transplantation, 77 (5), .
Abstract
Nonadherence to immunosuppressants is recognized to occur after renal transplantation, but the size of its impact on transplant survival is not known. A systematic literature search identified 325 studies (in 324 articles) published from 1980 to 2001 reporting the frequency and impact of nonadherence in adult renal transplant recipients. Thirty-six studies meeting the inclusion criteria for further review were grouped into cross-sectional and cohort studies and case series. Meta-analysis was used to estimate the size of the impact of nonadherence on graft failure. Only two studies measured adherence using electronic monitoring, which is currently thought to be the most accurate measure. Cross-sectional studies (n=15) tended to rely on self-report questionnaires, but these were poorly described; a median (interquartile range) of 22% (18%-26%) of recipients were nonadherent. Cohort studies (n=10) indicated that nonadherence contributes substantially to graft loss; a median (interquartile range) of 36% (14%-65%) of graft losses were associated with prior nonadherence. Meta-analysis of these studies showed that the odds of graft failure increased sevenfold (95% confidence interval, 4%-12%) in nonadherent subjects compared with adherent subjects. Standardized methods of assessing adherence in clinical populations need to be developed, and future studies should attempt to identify the level of adherence that increases the risk of graft failure. However, this review shows nonadherence to be common and to have a large impact on transplant survival. Therefore, significant improvements in graft survival could be expected from effective interventions to improve adherence.
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Published date: 15 March 2004
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Local EPrints ID: 24288
URI: http://eprints.soton.ac.uk/id/eprint/24288
ISSN: 0041-1337
PURE UUID: 54873503-4847-44cf-b806-bc0885a8f4a7
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Date deposited: 30 Mar 2006
Last modified: 28 Apr 2022 01:39
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Author:
Janet A. Butler
Author:
Juan C. Mason
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