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

Kunal Yadav, David M. Vock, Arthur J. Matas, William N. Robiner, Thomas E. Nevins

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

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. Results: Based on their average quantitative adherence to a single immunosuppressant drug over the first 6 months posttransplant, recipients were grouped into adherence tertiles (highest, >97.9% adherence; middle, 91-97.8%; lowest, <91%). The cumulative incidence of cancer was calculated for patients in each tertile, treating death as a competing risk. The association between adherence and cancer rate was calculated after adjusting for recipient risk factors, using a competing risk proportional hazards model. The median duration of follow-up was 10.1 years. The 10-year estimated cumulative cancer incidence was 59.4% in the most adherent, 36.1% in the middle group and 38.1% in the least adherent group (P = 0.006). Excluding nonmelanocytic skin cancers, cancer incidence remained significantly higher in the highest adherence group (P = 0.002). Conclusions: These data provide additional support for the need to individualize immunosuppression to minimize both rejection and immunosuppressive drug-related complications including cancer.

Original languageEnglish (US)
Pages (from-to)364-370
Number of pages7
JournalNephrology Dialysis Transplantation
Volume34
Issue number2
DOIs
StatePublished - Feb 1 2019

Keywords

  • Cancer
  • Immunosuppression
  • Kidney transplant
  • Medication adherence
  • Overimmunosuppression

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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