Medication noncompliance is a serious, but under-investigated problem in solid organ transplantation. This project takes advantage of electronic medication monitoring to obtain dynamic records of medication compliance after renal transplantation. This proposal will: expand studies of the natural history of post-transplant compliance in relation to discrete outcomes (acute rejection, graft loss, or death); continue a randomized study of intensive intervention to improve post-transplant compliance; and begin the examination of pre-transplant behaviors and psychological attributes predicting acute rejection, graft loss, or death.
Aim 1 - In a prospective cohort of 134 renal transplants, who have completed 4 years of monitored medication compliance, the association of noncompliance with chronic graft dysfunction will be further investigated. The role of medication noncompliance and """"""""drug holidays"""""""" in triggering late, acute transplant rejection will be more completely elucidated.
Aim 2 - 195 renal transplant patients are enrolled in a prospective intervention study aimed at improving medication compliance. """"""""High-risk"""""""" patients, with declining compliance, were randomized to intensive intervention or standard care. This study will continue to recruit patients and use discrete outcomes (acute rejection, graft loss, or death) to test intervention efficacy.
Aim 3 - A prospective study of 250 pre-transplant dialysis patients will monitor their medical compliance and measure behavioral characteristics while receiving dialysis therapy. Post-transplant, medication monitoring will continue, and patients will be followed for acute rejection, graft loss, or death. Identifying specific pre-transplant factors associated with post-transplant behaviors and outcomes may result in new strategies for pre-transplant interventions which could improve outcomes for both dialysis and renal transplant patients.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Program Projects (P01)
Project #
5P01DK013083-38
Application #
7550697
Study Section
Special Emphasis Panel (ZDK1)
Project Start
Project End
Budget Start
2006-04-01
Budget End
2007-03-31
Support Year
38
Fiscal Year
2006
Total Cost
$119,550
Indirect Cost
Name
University of Minnesota Twin Cities
Department
Type
DUNS #
555917996
City
Minneapolis
State
MN
Country
United States
Zip Code
55455
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Matas, Arthur J; Vock, David M; Ibrahim, Hassan N (2018) GFR ?25 years postdonation in living kidney donors with (vs. without) a first-degree relative with ESRD. Am J Transplant 18:625-631
Sanchez, Otto A; Ferrara, Laine K; Rein, Sarah et al. (2018) Hypertension after kidney donation: Incidence, predictors, and correlates. Am J Transplant 18:2534-2543
Kizilbash, Sarah J; Rheault, Michelle N; Bangdiwala, Ananta et al. (2017) Infection rates in tacrolimus versus cyclosporine-treated pediatric kidney transplant recipients on a rapid discontinuation of prednisone protocol: 1-year analysis. Pediatr Transplant 21:
Verghese, P S; Schmeling, D O; Filtz, E A et al. (2017) The impact of recipient BKV shedding before transplant on BKV viruria, DNAemia, and nephropathy post-transplant: A prospective study. Pediatr Transplant 21:
Serrano, Oscar Kenneth; Kandaswamy, Raja; Gillingham, Kristen et al. (2017) Rapid Discontinuation of Prednisone in Kidney Transplant Recipients: 15-Year Outcomes From the University of Minnesota. Transplantation 101:2590-2598
Ibrahim, H N; Berglund, D M; Jackson, S et al. (2017) Renal Consequences of Diabetes After Kidney Donation. Am J Transplant 17:3141-3148
Gross, Cynthia R; Reilly-Spong, Maryanne; Park, Taehwan et al. (2017) Telephone-adapted Mindfulness-based Stress Reduction (tMBSR) for patients awaiting kidney transplantation. Contemp Clin Trials 57:37-43
Ibrahim, Hassan N; Foley, Robert N; Reule, Scott A et al. (2016) Renal Function Profile in White Kidney Donors: The First 4 Decades. J Am Soc Nephrol 27:2885-93
Verghese, Priya; Gillingham, Kristen; Matas, Arthur et al. (2016) Post-transplant blood transfusions and pediatric renal allograft outcomes. Pediatr Transplant 20:939-945

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