Medication Monitoring in NT Indigenous kidney transplant recipients
Overview:
Kidney transplantation outcomes for Indigenous Australians have been consistently worse than those of non-Indigenous Australians. Analyses using ANZDATA have demonstrated that Indigenous transplant recipients, after adjustment for age and comorbid illness, had almost twice the risk of death of non-Indigenous recipients between 2000 and 2012, and a 60% increased chance of losing a kidney transplant. Highest risks were for Indigenous recipients from remote communities and occurred from six months to three years post-transplant.
From 1984 to 2004, Indigenous transplant recipients in the Northern Territory (NT) had 2.5 times the risk of acute rejection, twice the amount of immunosuppressive treatment for acute rejection and four times the risk of hospitalisation and post-transplant infection (particularly bacterial and fungal infections, with a wide variety of pathogens documented) compared to non-Indigenous recipients. Unlike non-Indigenous transplant recipients (in whom cardiac and cancer causes predominate), and in contrast with widespread health care professionals’ perceptions that immunosuppressive medication non-compliance is the major problem amongst Indigenous patients, infection has been the dominant cause of death or kidney transplant loss.
This is despite protocols for infection prophylaxis and pre-emptive treatment in immunosuppressed patients, developed in the NT. Periods of ‘under-immunosuppression’ (perhaps due to medication non-compliance) followed by acute rejection and then medically-driven ‘over-immunosuppression’ could play a role, but there are no data about this.
Aims:
Innovative approaches to managing patients’ immunosuppressive medication and environment are needed to address the excess burden of infections and high rates of acute rejection given the immunosuppressive medication currently available.
Objectives:
As a first step, we are piloting the incorporation of Med-ic electronic adherence monitoring technology into the Webster-pak blister-packed medication system currently in place for all Indigenous (and some non-Indigenous) kidney transplant recipients in the NT. We plan to enrol 20 Indigenous recipients of kidney transplants within the last five years for a period of three months continuous monitoring of medication use.
Our research has found:
For the first time in this high-risk transplant population, this adherence monitoring technology will provide accurate and detailed quantitative data about actual medication use. Together with data about patients’ perceptions about medication use post-transplant (gathered using qualitative methods in parallel with the quantitative data), this study is a step to understanding some of the challenges of the post-transplant journey for Indigenous patients in the NT, and may point to ways to improve their outcomes.
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Collaborators:
- Top End Health Service Clinicians