AUTHOR=Chambord Jérémy , Chauveau Bertrand , Djabarouti Sarah , Vignaud Jean , Taton Benjamin , Moreau Karine , Visentin Jonathan , Merville Pierre , Xuereb Fabien , Couzi Lionel 

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

JOURNAL=Transplant International

VOLUME=Volume 36 - 2023

YEAR=2023

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2023.11962

DOI=10.3389/ti.2023.11962

ISSN=1432-2277

ABSTRACT=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-month 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-month 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 clinicial suspicion of non-adherence.