TORNA ALL’ELENCO

NONADHERENCE TO TACROLIMUS IN ADULT LIVER AND KIDNEY TRANSPLANTATION IS ASSOCIATED WITH A HIGHER RISK OF EFFICACY FAILURE: REAL-WORLD EVIDENCE FROM ITALIAN ADMINISTRATIVE DATABASES in Value in Health

2018
AOU Città della Salute di Torino

Tipo pubblicazione

Conference Abstract

Autori/Collaboratori (9)Vedi tutti...

Veronesi C

Biancone L

Burra P


et alii...

Abstract

Objectives: The aim of this study was to assess the level of adherence to tacrolimus (TAC) and its association with clinical outcome in adult, maintenance liver (LTx) and kidney transplant (KTx) recipients. Methods: This was an observational, retrospective cohort study based on administrative data from 4 Italian regions. Adult (?18 years) recipients of a liver or kidney graft and transplanted between January 1, 2010 and December 31, 2015 were included. The study endpoints were evaluation of: 1) the proportion of adherence to TAC over 12 months after the first trimester posttransplantation, and defined as ?80% medication possession ratio (MPR); and 2) its association with the composite efficacy failure of death or re-transplantation (LTx), and of dialysis, re-transplantation or death (KTx) within 12 months after assessment of adherence. A multivariable, Cox regression model including age, gender, the Charlson Comorbidity Index (CCI), posttransplant non-immunosuppressive medication, and adherence to TAC was used. Results: Out of 336 LTx and 902 KTx patients, 254 (75.6%) and 718 (79.6%) were on TAC-based immunosuppression, respectively, and comprised the study population. Mean age was 54.1 and 50.5 years for LTx and KTx patients, respectively, while 75% and 61% were male, and 73% and 42% had a CCI score ?1. Adherence to TAC was 55.5% for LTx and 65.3% for KTx patients (p<0.01). Adherent LTx patients showed a lower, albeit not statistically significant, risk of composite efficacy failure versus non-adherent LTx recipients (HR=0.74 [95%CI 0.36-1.55], p=ns), while adherent KTx patients showed a significantly lower risk of composite efficacy failure versus non-adherent KTx recipients (HR=0.48[95%CI 0.28-0.80]; p<0.01). Conclusions: In keeping with previous evidence, adherence to TAC is frequent and associated with a higher risk of composite efficacy failure, especially for KTx patients.

DOI : 10.1016/j.jval.2018.09.991

Keywords

tacrolimus; adult; Charlson Comorbidity Index; clinical outcome; cohort analysis; conference abstract; controlled study; death; dialysis; drug therapy; female; first trimester pregnancy; gender; human; human tissue; immunosuppressive treatment; kidney graft; liver; major clinical study; male; middle aged; outcome assessment; recipient; retransplantation; retrospective study; treatment failure;