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Correlative Metrics of Adherence to Immunosuppression in Upper Extremity Transplantation – The Pittsburgh Experience
Firuz G. Feturi, B. Pharm; Vincent A. Chavanon, BA; Joseph E. Losee, MD; Mario G. Solari, MD; Raman Venkataramanan, PhD; Vijay S. Gorantla, MD, PhD; Alexander M. Spiess, MD
University of Pittsburgh
Plastic Surgery Department
2015-03-15
Presenter: Firuz G. Feturi, B. Pharm, PhD candidate
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
Director Name: Alexander Spiess
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Hand
We present our experience of NA monitoring in 5 patients (8 UETs) utilizing an objective and subjective measures.
METHOD
3 male, 2 female (ave. age 39.4 yrs), 4 Caucasian,1 Asian, cause of transp (3 disease and 2 trauma – Transplanted btw 2009 and 2010.
Patient Metrics: MMAQ 8 Score range from 0 [high adherence] to >2 [NA]. Protocol/Graft Metrics: Intrapatient variability of Tac exposure, acute rejection (AR, Banff) grade and DSA and Cylex ™ data. Clinician Metrics: Report of > 1 missed follow-up visit.
RESULTS
Pts 1, 4, and 5, reported moderate adherence and Pts 2 and 3 reported high adherence on MMAQ8. All pts showed highly variable trough Tac levels in first 6 mo (Mean ± SD, 10.5±3.9, 12.3±2.4, 15.9±4.3, 13.3±5.4, and 13.5±4.3). After 6 mo, Pt. 1 and 4 had wide swings in Tac troughs (C.V≥30%), recurrent, > Grade 2 AR, variable/high Cylex scores, and rising DSAs.
Objective (DSA, Biopsy results) and subjective (clinician) metrics significantly correlated with C.V of Tac levels (P <0.05 and 0.001), while MMAQ8 showed poor correlation (P=0.18). Sensitivity of Metrics: Clinician reports (25%), MMAQ8 (25%), SD Tac levels (63.6%), AR grade (87.5%). Specificity: Clinician reports (85%), MMAQ8 (50%), SD Tac levels (80%), AR grade (66.6%). NA based on Objective Metrics, 40% of the pts were NA, 40% were moderately adherent, and 20% were highly adherent.
Conclusion: no teams actively measure NA in UET . Prevalence of NA in VCA may thus be under-detected. Post-op assessment of pt behavior combined with clinical metrics can better estimate NA, ensuring timely intervention.
