Measurement of the Immunosuppressant Possession Ratio by Transplant Clinical Pharmacists Captures a Non-Adherence Associated With Antibody-Mediated Rejection.

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Chambord, Jeremy | Chauveau, Bertrand | Djabarouti, Sarah | Vignaud, Jean | Taton, Benjamin | Moreau, Karine | Visentin, Jonathan | Merville, Pierre | Xuereb, Fabien | Couzi, Lionel

Edité par CCSD ; Frontiers Media -

International audience. Our objective was to calculate an immunosuppressant possession ratio (IPR) to diagnose non-adherence at the time of antibody-mediated rejection (ABMR). IPR was defined as the ratio of number of pills collected at the pharmacy to the number of pills prescribed over a defined period. In a first cohort of 91 kidney transplant recipients (KTRs), those with an IPR 30% than patients with an IPR = 100% (66.7% vs. 29.4%, = 0.05). In a case-control study, 26 KTRs with ABMR had lower 6 months IPRs than 26 controls (76% vs. 99%, < 0.001). In KTRs with ABMR, non-adherence was more often diagnosed by a 6 months IPR < 90% than by clinical suspicion (73.1% vs 30.8%, = 0.02). In the multivariable analysis, only DSA and 6 months IPR < 90% were independently associated with ABMR, whereas clinical suspicion was not (odds ratio, 4.73; 95% CI, 1.17-21.88; = 0.03; and odds ratio, 6.34; 95% CI, 1.73-25.59; = 0.007, respectively). In summary, IPR < 90% is a quantifiable tool to measure immunosuppressant non-adherence. It is better associated with ABMR than clinical suspicion of non-adherence.

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