Learning to become self-sufficient and responsible is part of life’s journey through the teen and young adult years. Mistakes are often made, and lessons are learned. However, for young kidney-graft patients, any mistake or failure in keeping to their strict immunosuppressive therapy can lead to tragic results. In fact, low-adherence to medication remains a major contributor to the high level of organ rejection in this age group.
Transplant specialists and researchers from eight leading pediatric medical centers across Canada and the United States have united to help make a difference. Led by Dr. Bethany Foster, a pediatric nephrologist and scientist at the Research Institute of the McGill University Health Centre (RI-MUHC) and the Montreal Children’s Hospital of the MUHC, the team conducted a clinical trial named TAKE-IT aimed at testing a new intervention to improve adherence to treatment among adolescent kidney transplant recipients. Their results are published today online in The American Journal of Kidney Diseases (AJKD).
“Missing your anti-rejection medicine, even only a few times, can lead to graft failure,” says Dr. Foster, corresponding author of the study, who is also a researcher from the Child Health and Human Development Program at the RI-MUHC and a professor of Medicine at McGill University. “Given the shortage of organs available for transplant, every failure is not only a loss for the patient but also a loss for the transplant community.”
Medication non-adherence is a major problem in the 15 to 30 percent of children in North America who have a chronic illness, resulting in significant morbidity and mortality. It is also believed to be responsible for millions of dollars in potentially avoidable healthcare costs.
The TAKE-IT intervention used a combination of electronic medication monitoring and meetings with a personal coach every three months to encourage and develop adherence behavior. The researchers followed 169 adolescent and young adult kidney transplant recipients (aged 11 to 24) for a year. Participants used the SimpleMed electronic pillbox, developed by the medical company Vaica, to monitor their medication-taking. The cohort of patients was divided into two groups. The first group (81 patients) could customize the monitoring system to send them digital nudges like emails or text messages if they did not take their medicine on time. They also received coaching from people who were not part of or did not interact with the clinical team. Members of the second group, known as the control group (88 patients), didn’t receive electronic messaging or adherence coaching.
Results of the trial show that the young kidney transplant recipients who used the digital health medication management and adherence solution in combination with coaching had a 66 percent higher adherence to the anti-rejection medicine. Better adherence is likely to lead to better graft survival.Share