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

dc.rights.licenseopenen_US
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorPREZELIN-REYDIT, Mathilde
dc.contributor.authorDUBOIS, Valerie
dc.contributor.authorCAILLARD, Sophie
dc.contributor.authorPARISSIADIS, Anne
dc.contributor.authorETIENNE, Isabelle
dc.contributor.authorHAU, Francoise
dc.contributor.authorALBANO, Laetitia
dc.contributor.authorPOURTEIN, Monique
dc.contributor.authorBARROU, Benoit
dc.contributor.authorTAUPIN, Jean-Luc
dc.contributor.authorMARIAT, Christophe
dc.contributor.authorABSI, Lena
dc.contributor.authorVIGNEAU, Cecile
dc.contributor.authorRENAC, Virginie
dc.contributor.authorGUIDICELLI, Gwendaline
dc.contributor.authorVISENTIN, Jonathan
dc.contributor.authorMERVILLE, Pierre
dc.contributor.authorTHAUNAT, Olivier
dc.contributor.authorCOUZI, Lionel
dc.date.accessioned2021-08-24T07:58:50Z
dc.date.available2021-08-24T07:58:50Z
dc.date.issued2021-05-10
dc.identifier.issn2077-0383 (Print) 2077-0383en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/110193
dc.description.abstractEnBACKGROUND: Non-adherence with immunosuppressant medication (MNA) fosters development of de novo donor-specific antibodies (dnDSA), 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 dnDSA generation, acute rejection and GF. 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 dnDSA at year 2 post transplantation, using logistic regression models and the association between MNA and rejection or graft failure, using Cox multivariable models. RESULTS: The initial percentage of MNA patients was 17.7%, increasing to 34.6% at 24 months. Nineteen patients (8.4%) developed dnDSA 2 to 3 years after KT. After adjustment for recipient age, HLA sensitization, HLA mismatches, and maintenance treatment, MNA was associated neither with dnDSA occurrence, nor acute rejection. Only cyclosporine use and calcineurin inhibitor (CNI) withdrawal were strongly associated with dnDSA 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, dnDSA, and rejection, MNA was not associated with GF. The only parameters associated with GF were dnDSA occurrence, and acute rejection. CONCLUSIONS: Prospective serial monitoring of MNA using the Morisky scale does not predict dnDSA occurrence, rejection or GF in KTRs. In contrast, cyclosporine and CNI withdrawal induce dnDSA and rejection, which lead to GF.
dc.language.isoENen_US
dc.rightsAttribution 3.0 United States*
dc.rights.urihttp://creativecommons.org/licenses/by/3.0/us/*
dc.subject.enAdherence
dc.subject.enImmunosuppression
dc.subject.enKidney transplantation
dc.subject.endnDSA
dc.subject.enGraft survival
dc.title.enProspective Measures of Adherence by Questionnaire, Low Immunosuppression and Graft Outcome in Kidney Transplantation
dc.typeArticle de revueen_US
dc.identifier.doi10.3390/jcm10092032en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed34068497en_US
bordeaux.journalJournal of Clinical Medicineen_US
bordeaux.volume10en_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - UMR 1219en_US
bordeaux.issue9en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionINSERMen_US
bordeaux.institutionCNRS
bordeaux.teamBiostatisticsen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
hal.exportfalse
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