Self-reported non-adherence to immunosuppressive medication detected by the BAASIS predicts allograft rejections in kidney transplant recipients

Abstract:BACKGROUND: After kidney transplantation adherence to immunosuppressive medication is crucial for graft survival and its assessment requires valid measurements. The Basel Assessment of Adherence-to Immunosuppressive Medications Scale (BAASIS) is a validated self-report tool to detect non-adherence, however, its ability to predict clinically relevant outcomes remains to be established. METHODS: In this prospective cohort study including 226 consecutive kidney graft recipients transplanted at the Medical University of Vienna between 2018 and 2019 the adherence toward immunosuppressive medication was monitored for 2 years after transplantation. The BAASIS was applied at the first outpatient visit and at months 3, 6, 9, 12, and 24 post-transplant to assess the implementation and persistence phase of adherence. Non-adherence was defined by any positive response to one of the BAASIS-items. The primary endpoint was biopsy-proven allograft rejection defined by the Banff meeting report during a maximum follow-up of 4 years. RESULTS: Of the total study cohort [median age 56 years (IQR 46-63), 75 (33%) female], 125 recipients (55%) reported non-adherence at least once. Self-reported non-adherence increased within the first 3 months from 11% to 31% and remained between 27% and 32% at months 6 to 24 post-transplant. Non-adherent recipients experienced more allograft rejections than adherent patients (24%, n = 30 vs. 7%, n = 7; P < .001) during a median follow-up of 3.7 years (IQR 1.0-4.0). Using a time-dependent Cox regression model, the adjusted hazard ratio for allograft rejection associated with previously reported non-adherence was 2.90 (95% confidence interval (CI) 1.51-5.58; P = .001) accounting for recipient sex, age at transplantation, and history of previous transplantation. CONCLUSION: Our findings support the clinical value of the BAASIS. Its implementation into routine post-transplant care may facilitate the identification of clinically relevant medication non-adherence, enabling timely interventions.

Publication year:2025

Keywords:Surgery, Dermatology/urogenital system

Review status:Peer-reviewed