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Race and Electronically Measured Adherence to Immunosuppressive Medications after Deceased Donor Renal Transplantation

Francis L. Weng^*,,, Ajay K. Israni^*,,, Marshall M. Joffe^*,, Tracey Hoy^*,, Christina A. Gaughan^*,, Melissa Newman^*,, John D. Abrams^||, Malek Kamoun, Sylvia E. Rosas, Kevin C. Mange^*,,, Brian L. Strom^*,,, Kenneth L. Brayman^¶ and Harold I. Feldman^*,,

^* Center for Clinical Epidemiology and Biostatistics and Departments of Biostatistics and Epidemiology, Medicine, and Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, and ^|| Gift of Life Donor Program, Philadelphia, Pennsylvania; and ^¶ Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia

Address correspondence to: Dr. Harold I. Feldman, Biostatistics and Epidemiology, University of Pennsylvania, 923 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021. Phone: 215-898-0901; Fax: 215-898-0643; E-mail: hfeldman{at}cceb.med.upenn.edu

Received for publication December 8, 2004. Accepted for publication February 28, 2005.

Nonadherence to immunosuppressive medications may partly explain the worse allograft outcomes among black recipients of renal transplants. In a prospective cohort study of recipients of deceased donor renal transplants, microelectronic cap monitors were placed on bottles of one immunosuppressive medication to (1) measure average daily percentage adherence during the first posttransplantation year and (2) determine the factors associated with adherence. A total of 278 transplant recipients who provided sufficient microelectronic adherence data were grouped into four categories of average daily percentage adherence: 95 to 100% adherence (41.0% of patients), 80 to 95% adherence (32.4%), 50 to 80% adherence (12.9%), and 0 to 50% adherence (13.7%). In the unadjusted ordinal logistic regression model, black race was associated with decreased adherence (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.26 to 0.72; P = 0.001). Cause of renal disease, Powerful Others health locus of control, transplant center, and dosing frequency were also associated with adherence. After adjustment for transplant center and dosing frequency, the association between black race and decreased adherence was substantially attenuated (OR, 0.65; 95% CI, 0.38 to 1.14, P = 0.13). Transplant center (P = 0.003) and increased dosing frequency (OR, 0.43; 95% CI, 0.22 to 0.86, for three or four times per day dosing; OR, 2.35; 95% CI, 1.01 to 5.45, for daily dosing; versus two times per day dosing; P = 0.003) remained independently associated with adherence. Other baseline demographic, socioeconomic, medical, surgical, and psychosocial characteristics were not associated with adherence. The transplant center and dosing frequencies of immunosuppressive medications are associated with adherence and explain a substantial proportion of the race–adherence relationship.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673