Background/Purpose: Patient non-adherence has been reported as a potential adverse outcome predictor in renal transplantation (rTp) for patients with lupus nephritis (LN). We investigated potential factors leading to non-adherence and whether non-adherence is associated with increased rTp graft failure.

Methods: Patients with LN undergoing rTp in two major institutions were retrospectively included in this study, analysing prospectively captured data. The medical notes were reviewed for any documented concerns about non-adherence to prescribed treatment. Laboratory biochemical results (tacrolimus, mycophenalate mofetil (MMF) and ciclospirin levels) were also reviewed for evidence of non-adherence, defined as evidence of sub- therapeutic drug levels in routine measuring in >25% occurrences. Potential associations with poor adherence were examined including age, sex, race, age at SLE diagnosis, age at lupus nephritis diagnosis, age when dialysis was started, duration of SLE diagnosis, duration of lupus nephritis diagnosis, time on dialysis prior to rTp and medication use.

Results: All patients with rTp since 1975 were included. Forty patients had rTp from a total of 361 lupus patients in both centres. For 10 patients there were concerns documented in the medical records for non-adherence. For 9 patients (out of 16 biochemically tested) there was evidence of non-adherence, giving a total of 16 unique patients with concern about possible non-adherence to prescribed treatment for LN. There were no associations between patient demographics and non-adherence. In particular, in this cohort there was no association between age at SLE diagnosis or rTp, gender, race and diagnosis duration or medication prescribed and non-adherence (Table 1). However, having recorded a concern about possible non-adherence showed a trend in associating with increased graft rejection, hazard ratio of 3.40 when concerns existed compared to when no concerns were raised (95% CI=0.732-15.723, p=0.118).

Conclusion: There were no significant factors associating with non-adherence in this cohort. However, a concern about possible non-adherence (either recorded in the notes or as evidenced with biochemical assays) showed a trend towards a 3.4 higher risk of graft rejection. Further larger studies are warranted to investigate further the factors leading to non-adherence, and the true adverse effect of non-adherence on rTp in the context of LN.

Table 1 Patient demographic and characteristics in patients with non-adherence concerns versus patients where no concerns about non-adherence were raised.