Medication adherence and graft survival among heart transplant recipients

Boghani, Safia; Kirkham, Heather; Witt, Edward A.; Hira, Nishita; Cherikh, Wida S.; Wilk, Amber R.; Maghirang, Jude; Pietradoni, Glen
September 2019
Journal of Drug Assessment;2019 Supplement 1, Vol. 8, p7
Academic Journal
Background: Though medication adherence is essential for graft survival, little is known about the impact of non-adherence on heart transplant survival. Aims: The objective of this study was to examine the association between graft survival and adherence in heart transplant recipients. Methods: This retrospective, observational cohort study used claims data from a single, large national pharmacy chain (claims data from 2013-2016) and post-transplant follow-up data from the OPTN database (data from post-transplant to 2016). The sample included adult, deceased-donor heart transplant recipients (most recent if more than one) who had >2 pharmacy claims for any immunosuppressant >150 days apart in the 12-months after their first fill in the study period (2013–2016). Proportion of days covered (PDC) by any immunosuppressant for 12-months after first fill was calculated as a measure of adherence (defined as PDC >80%). Graft survival was defined as having a surviving graft at the end of the study period. Logistic regression was used to estimate the association between adherence and graft survival controlling for covariates (age at transplant, time since transplant, gender, race/ethnicity, copay, number of prescriptions for chronic conditions, pharmacy insurance plan, brand medication usage, digital fills, filling at a transplant specialized pharmacy, and receiving financial assistance). Results: Of the 3,435 heart transplant recipients who were eligible for the study, 75% were adherent and 81% had a surviving graft (range = 6–10,012 days post-transplant; median = 1,409 days). After adjusting for covariates, the odds of having a surviving graft were almost double for adherent patients than for non-adherent patients (OR = 1.94 [95% CI = 1.58–2.37]; p < 0.001). Other notable factors associated with graft survival included having three or fewer post-index prescriptions for chronic conditions (OR = 4.33 [3.55–5.27]; p < 0.001) and filling immunosuppressants digitally (OR = 2.25 [1.13–4.48]; p < 0.001). A sensitivity analysis using a PDC >90% as the definition for adherence showed that the odds of having a surviving graft were 2.01 (95% CI [1.67–2.43]) times more likely for adherent patients. Conclusions: This analysis suggests adherent patients had greater odds of having a surviving graft than those who were not adherent to immunosuppressants. Future studies should aim to show which patient behaviors contribute to medication adherence and what PDC threshold should be used for transplant research.


Related Articles

  • Molecular Identification of Trypanosoma cruzi Discrete Typing Units in End-Stage Chronic Chagas Heart Disease and Reactivation after Heart Transplantation. Burgos, Juan Miguel; Diez, Mirta; Vigliano, Carlos; Bisio, Margarita; Risso, Marikena; Duffy, Tomás; Cura, Carolina; Brusses, Betina; Favaloro, Liliana; Leguizamon, María Susana; Lucero, Raul Horacio; Laguens, Ruben; Levin, Mariano Jorge; Favaloro, Roberto; Schijman, Alejandro Gabriel // Clinical Infectious Diseases;9/1/2010, Vol. 51 Issue 5, p485 

    Background. One hundred years after the discovery of Chagas disease, it remains a major neglected tropical disease. Chronic Chagas heart disease (cChHD) is the most severe manifestation. Heart transplantation is the proper treatment for end-stage heart failure, although reactivation of disease...

  • Local man needs new heart. Hannigan, Michael V. // Malakoff News (TX);3/14/2008, Vol. 99 Issue 11, p1A 

    The article reports that 61-year-old Jerry Clinard and his family, who are residents of Malakoff, Texas, are asking for financial help to enable him to travel to the Methodist Hospital System in Houston where Clinard will undergo a heart transplant.

  • Cardiology.  // Clinical & Investigative Medicine;Aug97 Supplement, Vol. 20, pS5 

    Presents an abstract of the research manuscript `Selective blunting in endothelin-1 release and hemodynamic response to head-up tilt in heart transplant recipients,' by M. White, P. Cernacek et al from the Montreal Heart Institute.

  • Pregnancy in heart transplant recipients – current perspectives. Watson, William D; Bhagra, Sai K; Bhagra, Catriona J // Transplant Research & Risk Management;Aug2019, Vol. 11, p29 

    Successful pregnancy with a live birth and preserved graft function is possible in women following cardiac transplantation but requires careful assessment and planning in conjunction with the co-ordinated care of a specialist multidisciplinary team. Pregnancy poses significant risks to the...

  • Whole-genome sequencing based on formalin-fixed paraffin-embedded endomyocardial biopsies for genetic studies on outcomes after heart transplantation. Zar, Gustav; Smith, J. Gustav; Smith, Maya Landenhed; Andersson, Bodil; Nilsson, Johan // PLoS ONE;6/5/2019, p1 

    Background: Whole-genome sequencing (WGS) of heart transplant recipient- and donor-derived cardiac biopsies may facilitate organ matching, graft failure prediction, and immunotolerance research. The objective of this study was to determine the feasibility of WGS based on formalin-fixed...

  • Poster 184 Treating Low Back Pain in Cardiac Transplant Recipients: A Case Report. Bashir, Jamil; Cohen, Jackson; Panero, Alberto; Putcha, Nitin; Vasquez‐Duarte, Ricardo J. // PM & R: Journal of Injury, Function & Rehabilitation;Oct2012 Supplement 10S, Vol. 4, pS253 

    No abstract available.

  • Serious interaction between cyclosporin A and sulphadimidine.  // British Medical Journal (Clinical Research Edition);3/15/1986, Vol. 292 Issue 6522, p728 

    Reports several cases on serious interaction between cyclosporin A and sulphadimine. Use of orthotopic cardiac transplantated patients with pneumocystosis carinii pneumonia as subjects; Classification of patients; Identification of inadequate cyclosporin immunosuppression among patients after...

  • Heart and lung transplantation in patients with end stage lung disease. Penketh, Andrea; Higenbottam, Tim; Hakim, Moshsin; Wallwork, John // British Medical Journal (Clinical Research Edition);8/1/1987, Vol. 295 Issue 6593, p311 

    Examines the heart and lung transplantation in patients with end stage lung disease. Suitability of heart and lung transplantation in treating patients with end stage chronic lung disease; Indication of normal exercise tolerance among survivors; Improvements in lung function through heart and...

  • Heart transplant. Maiklem, Andrew; Nicol, Ed // BMJ: British Medical Journal (Overseas & Retired Doctors Edition;1/1/2011, Vol. 342 Issue 7787, p48 

    A personal narrative is presented which explores the author's experience of undergoing heart transplant after a minor heart attack.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics