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

Mathilde Prezelin-Reydit 1, 2, 3, * Valerie Dubois 4, 5 Sophie Caillard 6, 7 Anne Parissiadis 8 Isabelle Etienne 9 Francoise Hau 4 Laetitia Albano 10 Monique Pourtein 10 Benoit Barrou 11 Jean-Luc Taupin 12, 13 Christophe Mariat 14 Lena Absi 15 Cécile Vigneau 16, 17 Virginie Renac 18 Gwendaline Guidicelli 1 Jonathan Visentin 19, 1, 20 Pierre Merville 20, 19, 1 Olivier Thaunat 21, 22, 23 Lionel Couzi 1, 19, 20
Abstract : Background: 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.
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https://hal.archives-ouvertes.fr/hal-03245035
Contributor : Xavier Chard-Hutchinson <>
Submitted on : Tuesday, June 1, 2021 - 3:23:36 PM
Last modification on : Tuesday, July 20, 2021 - 4:02:26 AM

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Mathilde Prezelin-Reydit, Valerie Dubois, Sophie Caillard, Anne Parissiadis, Isabelle Etienne, et al.. Prospective Measures of Adherence by Questionnaire, Low Immunosuppression and Graft Outcome in Kidney Transplantation. Journal of Clinical Medicine, 2021, 10 (9), ⟨10.3390/jcm10092032⟩. ⟨hal-03245035⟩

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