{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T02:03:48Z","timestamp":1761789828395,"version":"build-2065373602"},"reference-count":49,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,5,10]],"date-time":"2021-05-10T00:00:00Z","timestamp":1620604800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Non-adherence with immunosuppressant medication (MNA) fosters development of de novo donor-specific antibodies (dnDSA), rejection, and graft failure (GF) in kidney transplant recipients (KTRs). However, there is no simple tool to assess MNA, prospectively. The goal was to monitor MNA and analyze its predictive value for dnDSA generation, acute rejection and GF. Methods: We enrolled 301 KTRs in a multicentric French study. MNA was assessed prospectively at 3, 6, 12, and 24 months (M) post-KT, using the Morisky scale. We investigated the association between MNA and occurrence of dnDSA at year 2 post transplantation, using logistic regression models and the association between MNA and rejection or graft failure, using Cox multivariable models. Results: The initial percentage of MNA patients was 17.7%, increasing to 34.6% at 24 months. Nineteen patients (8.4%) developed dnDSA 2 to 3 years after KT. After adjustment for recipient age, HLA sensitization, HLA mismatches, and maintenance treatment, MNA was associated neither with dnDSA occurrence, nor acute rejection. Only cyclosporine use and calcineurin inhibitor (CNI) withdrawal were strongly associated with dnDSA and rejection. With a median follow-up of 8.9 years, GF occurred in 87 patients (29.0%). After adjustment for recipient and donor age, CNI trough level, dnDSA, and rejection, MNA was not associated with GF. The only parameters associated with GF were dnDSA occurrence, and acute rejection. Conclusions: Prospective serial monitoring of MNA using the Morisky scale does not predict dnDSA occurrence, rejection or GF in KTRs. In contrast, cyclosporine and CNI withdrawal induce dnDSA and rejection, which lead to GF.<\/jats:p>","DOI":"10.3390\/jcm10092032","type":"journal-article","created":{"date-parts":[[2021,5,10]],"date-time":"2021-05-10T05:30:08Z","timestamp":1620624608000},"page":"2032","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Prospective Measures of Adherence by Questionnaire, Low Immunosuppression and Graft Outcome in Kidney Transplantation"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8302-7783","authenticated-orcid":false,"given":"Mathilde","family":"Prezelin-Reydit","sequence":"first","affiliation":[{"name":"Service de N\u00e9phrologie-Transplantation-Dialyse-Aph\u00e9r\u00e8se, H\u00f4pital Pellegrin, CHU de Bordeaux Pellegrin, 33076 Bordeaux, France"},{"name":"AURAD Aquitaine, 2 all\u00e9e des demoiselles, 33170 Gradignan, France"},{"name":"Equipe Biostatistique, INSERM U1219 BPH, 14 rue L\u00e9o Saignat, 33000 Bordeaux, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1169-7697","authenticated-orcid":false,"given":"Val\u00e9rie","family":"Dubois","sequence":"additional","affiliation":[{"name":"CIRI, INSERM U1111, CNRS UMR5308, Ecole Normale Sup\u00e9rieure de Lyon, Universit\u00e9 Claude Bernard Lyon I, 21, avenue Tony Garnier, 69007 Lyon, France"},{"name":"HLA Laboratory, French National Blood Service (EFS), 111, rue Elis\u00e9e-Reclus, 69153 D\u00e9cines-Charpieu, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophie","family":"Caillard","sequence":"additional","affiliation":[{"name":"Nephrology-Transplantation Department, University Hospital, 1 Place de l\u2019h\u00f4pital BP426, CEDEX, 67091 Strasbourg, France"},{"name":"INSERM UMR_S 1109, ImmunoRhumatologie Mol\u00e9culaire, F\u00e9d\u00e9ration Hospitalo-Universitaire OMICARE, F\u00e9d\u00e9ration de M\u00e9decine Translationnelle de Strasbourg, Institut d\u2019Immunologie et d\u2019H\u00e9matologie, 4 rue Kirschleger, CEDEX, 67085 Strasbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Parissiadis","sequence":"additional","affiliation":[{"name":"Histocompatibility Laboratory, UMR-S949 Inserm, Etablissement Fran\u00e7ais du Sang, 67000 Strasbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabelle","family":"Etienne","sequence":"additional","affiliation":[{"name":"Nephrology Department, CHU Rouen, 76000 Rouen, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fran\u00e7oise","family":"Hau","sequence":"additional","affiliation":[{"name":"Laboratory of Histocompatibility, EFS Hauts-de-France Normandie, 76000 Rouen, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laetitia","family":"Albano","sequence":"additional","affiliation":[{"name":"Service de N\u00e9phrologie-Dialyse-Transplantation, CHU de Nice, Universit\u00e9 C\u00f4te d\u2019Azur, 06000 Nice, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monique","family":"Pourtein","sequence":"additional","affiliation":[{"name":"Department of Immunology, Centre Hospitalier Universitaire de Nice, University Hospital of Nice, 06000 Nice, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beno\u00eet","family":"Barrou","sequence":"additional","affiliation":[{"name":"Department of Renal Transplantation, INSERM U 1082, Sorbonne Universit\u00e9, Piti\u00e9-Salp\u00eatri\u00e8re, 75013 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Luc","family":"Taupin","sequence":"additional","affiliation":[{"name":"Laboratory of Immunology and Histocompatibility, H\u00f4pital Saint-Louis APHP, 75010 Paris, France"},{"name":"INSERM U976 Institut de Recherche Saint-Louis, Universit\u00e9 Paris Diderot, 76013 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christophe","family":"Mariat","sequence":"additional","affiliation":[{"name":"Nephrology Department, CHU de Saint-Etienne, Groupe Immunit\u00e9 Muqueuse et Agents Pathog\u00e8nes (GIMAP), Jean Monnet University, Universit\u00e9 de Lyon, 42100 Saint-Etienne, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L\u00e9na","family":"Absi","sequence":"additional","affiliation":[{"name":"Laboratoire d\u2019Immunologie, EFS Loire-Auvergne, 25 Boulevard Pasteur, 42100 Saint-Etienne, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C\u00e9cile","family":"Vigneau","sequence":"additional","affiliation":[{"name":"Inserm, EHESP, Irset (Institut de recherche en sant\u00e9, environnement et travail)\u2014UMR_S 1085, Univ Rennes, CHU Rennes, 35000 Rennes, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4429-4421","authenticated-orcid":false,"given":"Virginie","family":"Renac","sequence":"additional","affiliation":[{"name":"HLA-HPA Laboratory, 35016 Rennes, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gwendaline","family":"Guidicelli","sequence":"additional","affiliation":[{"name":"Service d\u2019Immunologie et Immunog\u00e9n\u00e9tique, H\u00f4pital Pellegrin, CHU de Bordeaux Pellegrin, 33000 Bordeaux, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Visentin","sequence":"additional","affiliation":[{"name":"Service d\u2019Immunologie et Immunog\u00e9n\u00e9tique, H\u00f4pital Pellegrin, CHU de Bordeaux Pellegrin, 33000 Bordeaux, France"},{"name":"Unit\u00e9 Mixte de Recherche CNRS \u201cImmunoconcept\u201d 5164, 33076 Bordeaux, France"},{"name":"Universit\u00e9 de Bordeaux, 33000 Bordeaux, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8987-2929","authenticated-orcid":false,"given":"Pierre","family":"Merville","sequence":"additional","affiliation":[{"name":"Service de N\u00e9phrologie-Transplantation-Dialyse-Aph\u00e9r\u00e8se, H\u00f4pital Pellegrin, CHU de Bordeaux Pellegrin, 33076 Bordeaux, France"},{"name":"Unit\u00e9 Mixte de Recherche CNRS \u201cImmunoconcept\u201d 5164, 33076 Bordeaux, France"},{"name":"Universit\u00e9 de Bordeaux, 33000 Bordeaux, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3648-8963","authenticated-orcid":false,"given":"Olivier","family":"Thaunat","sequence":"additional","affiliation":[{"name":"CIRI, INSERM U1111, CNRS UMR5308, Ecole Normale Sup\u00e9rieure de Lyon, Universit\u00e9 Claude Bernard Lyon I, 21, avenue Tony Garnier, 69007 Lyon, France"},{"name":"Department of Transplantation, Nephrology and Clinical Immunology, Hospices Civils de Lyon, Edouard Herriot Hospital, 5, place d\u2019Arsonval, 69003 Lyon, France"},{"name":"Lyon-Est Medical Faculty, Claude Bernard University (Lyon 1), 8, avenue Rockfeller, 69373 Lyon, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9213-6196","authenticated-orcid":false,"given":"Lionel","family":"Couzi","sequence":"additional","affiliation":[{"name":"Service de N\u00e9phrologie-Transplantation-Dialyse-Aph\u00e9r\u00e8se, H\u00f4pital Pellegrin, CHU de Bordeaux Pellegrin, 33076 Bordeaux, France"},{"name":"Unit\u00e9 Mixte de Recherche CNRS \u201cImmunoconcept\u201d 5164, 33076 Bordeaux, France"},{"name":"Universit\u00e9 de Bordeaux, 33000 Bordeaux, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2921","DOI":"10.1111\/ajt.13347","article-title":"Rates and Determinants of 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Transplant."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3353","DOI":"10.1681\/ASN.2017030287","article-title":"Class II Eplet Mismatch Modulates Tacrolimus Trough Levels Required to Prevent Donor-Specific Antibody Development","volume":"28","author":"Wiebe","year":"2017","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2290","DOI":"10.1681\/ASN.2017020216","article-title":"Understanding Medication Nonadherence after Kidney Transplant","volume":"28","author":"Nevins","year":"2017","journal-title":"J. Am. Soc. 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Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/9\/2032\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:58:35Z","timestamp":1760162315000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/9\/2032"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,10]]},"references-count":49,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,5]]}},"alternative-id":["jcm10092032"],"URL":"https:\/\/doi.org\/10.3390\/jcm10092032","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2021,5,10]]}}}