The DOI matches its Crossref record; 40 of the 40 references it cites were found in a registry or an index.
A Retrospective Analysis of Immunosuppression Compliance, Dose Reduction and Discontinuation in Kidney Transplant Recipients
Open accessAbstract
We describe factors associated with poor compliance and dose reductions and examine the relative impact of compliance, dose reduction and discontinuation on graft outcome. Medicare claims for MMF in 7062 deceased donor renal recipients with at least 1 year of graft function were used to calculate compliance and dose reductions. Compliance was modeled using medication possession ratio to define quartiles for poor, low, medium and high compliance. The relative impact of compliance, dose reduction and discontinuation on graft outcome was assessed with Cox proportional hazards. Pediatric (Age 0-18, Odds ratio = 1.71, 95% CI 1.11-2.63, p = 0.014) and adolescent recipients (19-24, 1.57, 1.23-2.00, p < 0.001) were more likely poorly compliant compared to adults age 25-44. Poor compliance was also associated with physical limitations, hypertension, delayed graft function, rejection, infection and GI conditions. Poor (1.43, 1.11-1.84, p = 0.005) and low (1.46, 1.13-1.88, p = 0.004) compliance was associated with an increased hazard of graft loss as was >50% dose reduction (1.69, 1.15-2.50, p = 0.008) and discontinuation (8.34, 6.85-10.2, p < 0.001). Medication possession ratios lower than the 3-year mean were associated with an increased risk of graft loss. These results may indicate that interventions to improve compliance among kidney transplant recipients should strive for high rather than discourage low compliance.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Other groups used the discrepancy between immunosuppressant dosages and prescription refills or data from health insurances for the assessment of adherence[35,36].”
From Adherence is associated with a favorable outcome after lung transplantation (2019) · cites this paper as [36]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987) · Journal of Chronic Diseases · doi:10.1016/0021-9681(87)90171-8 · Cited by 49,742 · cited 1×
“developed a prognostic taxonomy of comorbid conditions ( 23 ).”
BackgroundAdapting a clinical comorbidity index for use with ICD-9-CM administrative databases
DEYO, R. (1992) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(92)90133-8 · Cited by 10,452 · cited 1×
“One aspect of comorbidity indices that make them particularly useful for outcomes research is that they have been adapted for use with administrative claims data (24,25).”
MethodComorbidity measures for use with administrative data.
Elixhauser, A., Steiner, C., Harris, D. R., & Coffey, R. M. (1998) · Medical Care · doi:10.1097/00005650-199801000-00004 · Cited by 9,921 · cited 1×
“One aspect of comorbidity indices that make them particularly useful for outcomes research is that they have been adapted for use with administrative claims data (24,25).”
MethodSollinger, H. W. (1995) · Transplantation · doi:10.1097/00007890-199508000-00003 · Cited by 1,384
Diabetes Mellitus after Kidney Transplantation in the United States
Kasiske, B. L., Snyder, J. J., Gilbertson, D. T., & Matas, A. J. (2003) · American Journal of Transplantation · doi:10.1034/j.1600-6143.2003.00010.x · Cited by 1,286
Strategies to Improve Long-Term Outcomes after Renal Transplantation
Pascual, M. A., Theruvath, T. P., Kawai, T., TOLKOFF-RUBIN, N. E., & Cosimi, A. B. (2002) · New England Journal of Medicine · doi:10.1056/nejmra011295 · Cited by 838 · cited 1×
“MMF has been shown to be an effective adjunct to calcineurin inhibitor (CNI) regimens for preventing acute (27) and chronic rejection (28,29) of renal allografts, and has become the standard adjunct immunosuppressant at most transplant centers in the United States (30).”
BackgroundA Checklist for Medication Compliance and Persistence Studies Using Retrospective Databases
Peterson, A. M., Nau, D. P., Cramer, J. A., Benner, J., Gwadry-Sridhar, F. H., & Nichol, M. B. (2006) · Value in Health · doi:10.1111/j.1524-4733.2006.00139.x · Cited by 638 · cited 3×
“MPR has been used to assess compliance to anti-hyperglycemic, lipid-lowering and anti-hypertensive therapies (13).”
BackgroundMethodInfluentialButler, J. A., Roderick, P., Mullee, M., Mason, J. C., & Peveler, R. (2004) · Transplantation · doi:10.1097/01.tp.0000110408.83054.88 · Cited by 545
Estimating medication persistency using administrative claims data.
Sikka, R., Xia, F., & Aubert, R. E. (2005) · PubMed · Cited by 456
Denhaerynck, K., Dobbels, F., Cleemput, I., Desmyttere, A., Schafer-Keller, P., Schaub, S., & De Geest, S. (2005) · Transplant International · doi:10.1111/j.1432-2277.2005.00176.x · Cited by 424 · cited 9×
“Most other studies have either used rejection as an endpoint or estimated the percentage of graft losses attributable to poor compliance (2,11).”
BackgroundMethodInfluential
Cited by
Sorted by citations
Transplant Outcomes and Economic Costs Associated with Patient Noncompliance to Immunosuppression
Pinsky, B. W., Takemoto, S., Lentine, K. L., Burroughs, T. E., Schnitzler, M. A., & Salvalaggio, P. R. D. O. (2009) · American Journal of Transplantation · doi:10.1111/j.1600-6143.2009.02798.x · Cited by 331
“Using this methodology, we recently found that poor compliance with MMF was associated with 43–46% increased risk of graft failure (14).”
MethodSelf-citationDobbels, F., Ruppar, T. M., Geest, S. D., Decorte, A., Damme‐Lombaerts, R. V., & Fine, R. Ν. (2009) · Pediatric Transplantation · doi:10.1111/j.1399-3046.2010.01299.x · Cited by 306
“2007 (19) USA N = 40 (adolescents out of larger study) Retrospective analysis Prescription refill Medication possession ratio (MPR) over a 1–3-year time period (divided in quartiles using time dependent analysis): high adherence >98% MPR; medium between 81 and 98%, low between 69 and 81%; and poor: <69% 44% Adherence…”
BackgroundNonadherence Consensus Conference Summary Report
Fine, R. Ν., Becker, Y. T., Geest, S. D., Eisen, H. J., Ettenger, R. B., Evans, R., Rudow, D. L., McKay, D. B., Neu, A. M., Nevins, T. E., et al. (2008) · American Journal of Transplantation · doi:10.1111/j.1600-6143.2008.02495.x · Cited by 297
“<95% adherence to the immunosuppressive regimen) are sufficient to result in poor outcomes (10,14).”
BackgroundInterventions to improve medication-adherence after transplantation: a systematic review
Bleser, L. D., Matteson, M., Dobbels, F., Russell, C. L., & Geest, S. D. (2009) · Transplant International · doi:10.1111/j.1432-2277.2009.00881.x · Cited by 248
“2 Counseling/behavioral interventions targeted, shaped, and/or reinforced behavior, empowered patients to participate in their care, positively changed a patient’s skill level or normal routine [3,7,8].”
BackgroundMethodResultInfluentialImproved Adherence to Tacrolimus Once-Daily Formulation in Renal Recipients
Kuypers, D. R. J., Peeters, P. C., Sennesael, J. J., Kianda, M. N., Vrijens, B., Kristanto, P., Dobbels, F., Vanrenterghem, Y. F. C., & Kanaan, N. (2012) · Transplantation · doi:10.1097/tp.0b013e3182725532 · Cited by 228
Metadata
- Authors
- Takemoto, S. K., Pinsky, B. W., Schnitzler, M. A., Lentine, K. L., Willoughby, L. M., Burroughs, T. E., & Bunnapradist, S.
- Affiliations
- Saint Louis University (US)
- University of California, Los Angeles (US)
- Corresponding author
- Takemoto, S.K.
- Venue
- American Journal of Transplantation
- Publisher
- Elsevier BV
- Published
- 2007-12
- Volume
- 7
- Issue
- 12
- Pages
- 2704-2711
- ISSN
- 1600-6135 (ISSN-L)
- OpenAlex
- W2020224358
- Cited by
- 202
- References
- 40
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 7 · 2022: 7 · 2021: 12 · 2020: 7 · 2019: 14 · 2018: 8 · 2017: 6 · 2016: 7 · 2015: 9 · 2014: 20 · 2013: 15 · 2012: 23
- FWCI
- 9.09
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- American Journal of Transplantation (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Diabetes and Digestive and Kidney Diseases (K08DK073036)
- Topics
- Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Keywords
- kidney transplantation, medication possession ratio, mycophenolate mofetil, dose reduction, drug discontinuation, graft loss, graft rejection, delayed graft function, hypertension, gastrointestinal diseases
- MeSH terms
- Adolescent, Adult, Child, Child, Preschool, Dose-Response Relationship, Drug, Gastrointestinal Diseases, Graft Rejection, Medicare, Humans, Immunosuppressive Agents, Infant, Infant, Newborn, Insurance Claim Review, Middle Aged, Mycophenolic Acid, Patient Compliance, Retrospective Studies, Risk Factors, United States, Logistic Models, Proportional Hazards Models, Kidney Transplantation, Treatment Outcome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
