{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T06:56:55Z","timestamp":1772434615483,"version":"3.50.1"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontierspartnerships.org"],"crossmark-restriction":true},"short-container-title":["Transpl. Int."],"abstract":"<jats:p>\n                    Calcineurin inhibitor (CNI) trough concentrations and their variability are frequently used as adherence proxies, despite limited validation. We evaluated the association between self-reported adherence and CNI exposure during the first year after kidney transplantation. We included 619 patients from two prospective French cohorts (14,829 C\n                    <jats:sub>0<\/jats:sub>\n                    values). Adherence was assessed using the MMAS-4 questionnaire. CNI exposure was evaluated via C\n                    <jats:sub>0<\/jats:sub>\n                    levels, intra-patient variability (IPV; CV threshold = 30%), and underexposure rates. Cross-sectional and longitudinal analyses were performed. No significant differences in C\n                    <jats:sub>0<\/jats:sub>\n                    , IPV, or underexposure were observed between adherent and non-adherent patients, regardless of the CNI used or analytical approach. In longitudinal analysis, IPV was similar (31.3% [25.5\u201338.2] vs. 31.6% [23.6\u201338.9], p = 0.68), as was the proportion of patients with high IPV (55.5% vs. 51.5%, p = 0.5). At 3 years, high IPV was not significantly associated with rejection (HR 1.02 [0.67\u20131.55], p = 0.93). Self-reported adherence was not associated with CNI C\n                    <jats:sub>0<\/jats:sub>\n                    levels, IPV, or underexposure. CNI C\n                    <jats:sub>0<\/jats:sub>\n                    variability alone cannot reliably detect non-adherence and should not be interpreted as a standalone adherence marker. Multimodal strategies combining pharmacokinetics with validated self-report tools are needed to evaluate adherence.\n                  <\/jats:p>","DOI":"10.3389\/ti.2026.15718","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T06:10:14Z","timestamp":1772431814000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["CNI Trough Variability Does Not Reliably Reflect Medication Adherence: Insights From a 3-Year Follow-Up Study"],"prefix":"10.3389","volume":"39","author":[{"given":"Claire","family":"Villeneuve","sequence":"first","affiliation":[{"name":"CHU Limoges, Department of Pharmacology, Toxicology and Centre of Pharmacovigilance","place":["Limoges, France"]},{"name":"INSERM, UMR-1248","place":["Limoges, France"]},{"name":"FHU SUPORT","place":["Limoges, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-phillipe","family":"Rerolle","sequence":"additional","affiliation":[{"name":"INSERM, UMR-1248","place":["Limoges, France"]},{"name":"FHU SUPORT","place":["Limoges, France"]},{"name":"Department of Nephrology, Dialysis and Transplantation","place":["Limoges, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lionel","family":"Couzi","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Transplantation, Dialysis, Centre Hospitalier Universitaire (CHU) Pellegrin","place":["Bordeaux, France"]},{"name":"CNRS-UMR 5164 Immuno ConcEpT, Bordeaux University","place":["Bordeaux, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre-Francois","family":"Westeel","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Kidney Transplantation, University Hospital of Amiens","place":["Amiens, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabelle","family":"Etienne","sequence":"additional","affiliation":[{"name":"Service de Nephrologie, Rouen University Hospital","place":["Rouen, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laure","family":"Esposito","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Organ Transplantation, CHU Toulouse","place":["Toulouse, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nassim","family":"Kamar","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Organ Transplantation, CHU Toulouse","place":["Toulouse, France"]},{"name":"INFINITY-Inserm U1291-CNRS U5051 University Paul Sabatier","place":["Toulouse, France"]},{"name":"INSERM U1043, IFR-BMT, CHU Purpan","place":["Toulouse, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mathias","family":"B\u00fcchler","sequence":"additional","affiliation":[{"name":"FHU SUPORT","place":["Limoges, France"]},{"name":"Department of Nephrology and Transplantation, University of Tours","place":["Tours, France"]},{"name":"\u00c9quipe d'accueil4245, Fran\u00e7ois Rabelais University","place":["Tours, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antoine","family":"Thierry","sequence":"additional","affiliation":[{"name":"FHU SUPORT","place":["Limoges, France"]},{"name":"CHU Poitiers, Department of Nephrology, Dialysis and Transplantation","place":["Poitiers, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre","family":"Marquet","sequence":"additional","affiliation":[{"name":"CHU Limoges, Department of Pharmacology, Toxicology and Centre of Pharmacovigilance","place":["Limoges, France"]},{"name":"INSERM, UMR-1248","place":["Limoges, France"]},{"name":"FHU SUPORT","place":["Limoges, France"]},{"name":"University Limoges, Faculty of Medicine","place":["Limoges, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline","family":"Monchaud","sequence":"additional","affiliation":[{"name":"CHU Limoges, Department of Pharmacology, Toxicology and Centre of Pharmacovigilance","place":["Limoges, France"]},{"name":"INSERM, UMR-1248","place":["Limoges, France"]},{"name":"FHU SUPORT","place":["Limoges, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/j.pec.2019.08.002","article-title":"Adherence Profiles in Kidney Transplant Patients: Causes and Consequences","volume":"103","author":"Villeneuve","year":"2020","journal-title":"Patient Educ 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