Depression, Quantified Medication Adherence, and Quality of Life in Renal Transplant Candidates and Recipients.

Like patients with many chronic illnesses, ESRD patients experience psychological challenges with greater incidence of depression and reduced quality of life (QoL). A series of 139 transplant candidates' depression and QoL, and a subset of 82 candidates' medication adherence were monitored, revealing heterogenous patterns of depression and adherence and reduced QoL. Twenty-eight patients who received kidney transplants were re-evaluated 6 months post-transplant revealing mixed patterns.

Medication adherence is associated with an increased risk of cancer in kidney transplant recipients: a cohort study.

Background: Nonadherence to posttransplant immunosuppressive medication is associated with increased rates of rejection and graft loss, yet it is unknown to what degree ideal adherence is associated with the sequelae of overimmunosuppression. Specifically, we questioned whether excellent adherence increased the posttransplant cancer risk.

Methods: Between August 1998 and August 2006, 195 consenting kidney transplant recipients had electronic monitoring of theirimmunosuppressive medication adherence.

Improved Outcomes of Kidney Transplantation in Infants (Age < 2 years): A Single-Center Experience.

Background: Infants (age, < 2 years) with end-stage renal disease (ESRD) have increased morbidity and mortality. We evaluated our long-term outcomes of kidney transplants (KTx) in infants.

Methods: Between 1984 and 2014, 136 infants underwent KTx.

Class II Eplet Mismatch Modulates Tacrolimus Trough Levels Required to Prevent Donor-Specific Antibody Development.

Despite more than two decades of use, the optimal maintenance dose of tacrolimus for kidney transplant recipients is unknown. We hypothesized that HLA class II donor-specific antibody (DSA) development correlates with tacrolimus trough levels and the recipient's individualized alloimmune risk determined by HLA-DR/DQ epitope mismatch. A cohort of 596 renal transplant recipients with 50,011 serial tacrolimus trough levels had HLA-DR/DQ eplet mismatch determined using HLAMatchmaker software.

Understanding Medication Nonadherence after Kidney Transplant.

Alloimmunity remains a barrier to long-term graft survival that necessitates lifelong immunosuppressive therapy after renal transplant. Medication nonadherence has been increasingly recognized as a major impediment to achieving effective immunosuppression. Electronic medication monitoring further reveals that nonadherence manifests early after transplant, although the effect is delayed.

Desirability and feasibility of wireless electronic monitoring of medications in clinical trials.

Medication nonadherence is a vexing problem in health care necessitating patients and health professionals' efforts to prevent, minimize, or reverse it. Research participants' inconsistent medication taking obscures treatment efficacy and adds costs to biomedical research. Electronic monitoring devices (EMDs), like the Medication Event Monitoring System (MEMS), have grown in sophistication, providing precise, timely insights into individuals' medication-taking patterns across clinical populations.

Predictive patterns of early medication adherence in renal transplantation.

Background: Patients' adherence with posttransplant immunosuppression is known to affect renal transplant outcomes.

Methods: Prospectively, individual medication adherence patterns in 195 kidney transplant recipients were quantified with electronic medication monitors. Monitored drugs were mycophenolate mofetil, sirolimus, or azathioprine.

The pharmacokinetics of valganciclovir prophylaxis in pediatric solid organ transplant patients at risk for Epstein-Barr virus disease.

Antiviral prophylaxis with valganciclovir is used frequently in pediatric solid organ transplant patients to prevent Epstein-Barr virus (EBV)-induced infections and tissue-invasive disease including post-transplant lymphoproliferative disorder (PTLD). This approach is untested in clinical trials and valganciclovir dosing strategies in children are highly variable. Our objective was to characterize the pharmacokinetics of ganciclovir in the plasma of pediatric kidney and liver transplant patients taking valganciclovir for EBV prophylaxis.

Outcomes of infants <28 days old treated with peritoneal dialysis for end-stage renal disease.

This study evaluates the long-term outcomes of infants with end stage renal disease (ESRD) who required initiation of chronic peritoneal dialysis (PD) prior to 28 days of age. Infants with ESRD present both ethical and technical challenges for pediatric nephrologists and neonatologists. Recent advances in the medical management of ESRD in infants combined with improved infant transplantation outcomes make it more likely that such infants can survive to successful kidney transplantation.

Quantitative patterns of azathioprine adherence after renal transplantation.

Background: Renal transplant recipients regularly fail to take their prescribed immunosuppressive medications, frequently leading to adverse outcomes.

Methods: Medication vials incorporating electronic monitor circuits in their caps compiled prospective data files on the azathioprine dosing patterns of 180 adult renal transplant recipients monitored up to 4 years. These patients were followed for a mean of 8.

Hematuria in children due to schistosomiasis in a nonendemic setting.

Infection with Schistosoma hematobium is common in immigrants from tropical Africa and commonly presents with painless hematuria. Since chronic, heavy infection can lead to significant morbidity, it is imperative for clinicians who serve the immigrant and refugee population to become familiar with this traditionally exotic disease. Increased awareness will allow earlier diagnosis and treatment of infection, avoiding complications and minimizing expensive and invasive diagnostic procedures.

"Why do they do that?" The compliance conundrum.

The problem of compliance or adherence with medical advice is complex in every aspect. Frequently compliance definitions vary, measurements are not well quantified, interventions are uncontrolled or not fully elaborated. Nevertheless the importance of facilitating and maximizing compliance is undeniable.

Medication noncompliance: another iceberg's tip.

After renal transplantation, immunosuppressive medications must be taken long-term to avoid acute rejection and the cascade of events leading to "chronic allograft dysfunction" and loss. In the past, when posttransplant immunosuppression was limited to azathioprine and prednisone, acute rejection episodes were common, and it was difficult to identify the impact of medication noncompliance. However, with more potent and effective drugs, acute rejection is uncommon, and medication noncompliance emerges as an increasingly important factor in the outcome of solid-organ transplantation.

Non-compliance and its management in teenagers.

Renal transplantation restores a patient's endogenous renal function. The benefits of this restoration are especially dramatic in children. However, transplantation is a complex and expensive therapy which, when successful, requires consistent adherence to a complex regimen of drug therapy and clinical follow-up.