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

Autor:	Chambord J; Service de Pharmacie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Chauveau B; Service d'Anatomopathologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.; CNRS-UMR 5164 ImmunoConcEpT, Université de Bordeaux, Bordeaux, France., Djabarouti S; Service de Pharmacie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.; INSERM U1312 BRIEC, Université de Bordeaux, Bordeaux, France., Vignaud J; Service de Pharmacie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Taton B; Service de Néphrologie, Transplantation, Dialyse, Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Moreau K; Service de Néphrologie, Transplantation, Dialyse, Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Visentin J; CNRS-UMR 5164 ImmunoConcEpT, Université de Bordeaux, Bordeaux, France.; Service d'Immunologie et Immunogénétique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Merville P; CNRS-UMR 5164 ImmunoConcEpT, Université de Bordeaux, Bordeaux, France.; Service de Néphrologie, Transplantation, Dialyse, Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France., Xuereb F; Service de Pharmacie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.; INSERM U1034, Université de Bordeaux, Bordeaux, France., Couzi L; CNRS-UMR 5164 ImmunoConcEpT, Université de Bordeaux, Bordeaux, France.; Service de Néphrologie, Transplantation, Dialyse, Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
Jazyk:	angličtina
Zdroj:	Transplant international : official journal of the European Society for Organ Transplantation [Transpl Int] 2023 Nov 28; Vol. 36, pp. 11962. Date of Electronic Publication: 2023 Nov 28 (Print Publication: 2023).
DOI:	10.3389/ti.2023.11962
Abstrakt:	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 < 90% had more frequently a tacrolimus through level coefficient of variation >30% than patients with an IPR = 100% (66.7% vs. 29.4%, p = 0.05). In a case-control study, 26 KTRs with ABMR had lower 6 months IPRs than 26 controls (76% vs. 99%, p < 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%, p = 0.02). In the multivariable analysis, only de novo 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; p = 0.03; and odds ratio, 6.34; 95% CI, 1.73-25.59; p = 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. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2023 Chambord, Chauveau, Djabarouti, Vignaud, Taton, Moreau, Visentin, Merville, Xuereb and Couzi.)
Databáze:	MEDLINE
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