Trajectories of Immunosuppressive Medication Adherence Among Kidney Transplant Recipients: A 2-Year Prospective Cohort Study.

BACKGROUND

Immunosuppressive medication (IM) adherence, a dynamic and time-dependent behavior, is typically suboptimal among kidney transplant recipients (KTRs) and severely impacts their prognosis. Longitudinal data regarding the temporal trajectories of medication adherence are important for devising targeted intervention strategies.

OBJECTIVE

To identify the trajectories of IM adherence in KTRs over the 2 years post transplantation.

METHODS

Two hundred and twenty-two KTRs were recruited from a tertiary care hospital in China between May 2020 and February 2022. Data were collected at 3-, 6-, 12-, and 24-month post kidney transplantation. IM adherence was defined according to the BAASIS scale. A group-based trajectory model was used to depict and identify distinct trajectories. Univariate analysis and multinomial logistic regression were conducted to evaluate the association between baseline factors and membership in different trajectory groups.

RESULTS

The prevalence of medication non-adherence at 3, 6, 12, and 24 months after transplantation was 10.8%, 9.9%, 11.7%, and 22.1%, respectively. Three adherence trajectories were identified, including the "consistent adherence" (65.5%), "high start and decreasing adherence" (28.0%), and "increasing adherence" (6.6%) trajectory group. The critical transition point, as the 6-month time point after transplantation, in adherence dynamics was identified. Recipients experiencing decreasing adherence trajectories were possibly younger, received a technical/high school education, and lived alone.

CONCLUSIONS

Distinct trajectories of medication adherence among KTRs were identified during the 2-year post-transplantation period. A previously unrecognized adherence trajectory-the "increasing adherence" trajectory and the critical transition point in adherence dynamics was identified, particularly highlighting the 6-month post transplantation period as a pivotal intervention window.