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Frequency and impact of nonadherence to immunosuppressants after renal transplantation: a systematic review

Record type: Article

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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Citation

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), pp. 769-776.

More information

Published date: 15 March 2004

Identifiers

Local EPrints ID: 24288
URI: http://eprints.soton.ac.uk/id/eprint/24288
ISSN: 0041-1337
PURE UUID: 54873503-4847-44cf-b806-bc0885a8f4a7
ORCID for Paul Roderick: ORCID iD orcid.org/0000-0001-9475-6850
ORCID for Robert C. Peveler: ORCID iD orcid.org/0000-0001-5596-9394

Catalogue record

Date deposited: 30 Mar 2006
Last modified: 17 Jul 2017 16:14

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Contributors

Author: Janet A. Butler
Author: Paul Roderick ORCID iD
Author: Mark Mullee
Author: Juan C. Mason

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