INTERVENTION TO IMPROVE MEDICAL ADHERENCE IN PEDIATRIC KIDNEY TRANSPLANT RECIPIENTS

Background: Adolescent age at transplantation has long been recognized as a risk factor for graft failure, and a major contributor might be medical nonadherence. Many interventions have been applied to improve adherence in adults. However, there is limited data about intervention in pediatric kidney transplant recipients. Objectives: The study aimed to study the improvement of medical adherence in pediatric kidney transplant recipients after receiving the intervention and to evaluate the associated factors to medical nonadherence Methods: A single-center randomized controlled trial was conducted on pediatric kidney transplant recipients at Phramongkutklao Hospital, aged below 21 years, with at least one year post-transplantation and without acute rejection within three months. Randomization was 1:1. The intervention included educational sessions with individual booklets, telephone calls, or video call visits every two weeks, with regular assessment of adherence. Adherence was assessed using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) and the coefficient of variation (CV%) of tacrolimus level. Results: Thirty-three patients were eligible: 17 for intervention and 16 for control. The mean age was 15.7±3.12 years. Nonadherence prevalence at baseline was 30.3% by questionnaire and 40.7% by %CV. After one year, the total number of non-adherents decreased to 21.2% using the questionnaire and 15.4% using %CV, but there was no difference between the intervention and control groups. After performing a multivariate analysis to evaluate the factors associated with medical nonadherence, no factor was significantly associated. However, some factors, such as the total number of prescribed drugs, tended to be significant (p = 0.071 and 0.331 using univariate and multivariate analysis, respectively). Conclusion: The prevalence of medical nonadherence in pediatric kidney transplant recipients is higher than in adults. Medical nonadherence is complex; interventions must be individualized and done with a multidisciplinary team. Keywords: medical nonadherence