Meta-analysisindependent cross-checkabstract only checked★ key study I-INTB-09 in-depth review
Skipping transplant drugs often leads to losing the kidney
Frequency and impact of nonadherence to immunosuppressants after renal transplantation: a systematic review.
Overview
Butler JA et al.. Transplantation 2004 · PMID 15021846 · DOI 10.1097/01.tp.0000110408.83054.88
Not taking immunosuppressants was linked to about seven times higher odds of graft failure.
Does the study support the specific claim? No · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Measure impact of nonadherence
- How was the study done?
Systematic review
- How many people, animals or samples were studied?
36 studies
- What was actually found?
Nonadherence common; strongly linked to graft loss
- How large was the observed effect?
about 7-fold odds of graft failure
- What do the results mean in everyday life?
Transplant medicines protect the new kidney; stopping them is a major cause of losing it.
- What are the study's limitations?
Self-report measures; abstract only
- What does it say about Elawady's specific claim?
Contradicts stopping immunosuppression.
- Do the results apply to Germany and Europe?
High
- What can explicitly not be concluded from this study?
Cannot predict the outcome for one individual patient.
Scientific in-depth review
1. Full reference
- Authors
- Butler JA et al.
- Journal
- Transplantation
- Year
- 2004
- Identifier
- PMID 15021846 DOI 10.1097/01.tp.0000110408.83054.88
- Verification
- verified – PubMed efetch 2026-10-25
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Research Support, Non-U.S. Gov't (publication type); no COI statement in record
2. Research question
How frequent is nonadherence to immunosuppressants after kidney transplantation and how does it affect graft survival?
3. Study design and population
- Study design
- Meta-analysis – Systematic review with meta-analysis of cohort studies
- Population
Adult kidney-transplant recipients
- Country
Multinational
- Period
studies 1980-2001
- Sample size
36 studies included (325 screened)
- Inclusion and exclusion criteria
Adult renal transplant recipients; studies reporting frequency or impact of nonadherence
4. Methods and endpoints
- Exposure / intervention
Nonadherence to immunosuppressants
- Comparator
Adherent recipients
- Endpoints
Graft failure
- Statistical methods
Meta-analysis of cohort studies
5. Actual results
- Results
Median 22% (IQR 18-26%) of recipients were nonadherent in cross-sectional studies. In cohort studies a median 36% (IQR 14-65%) of graft losses were associated with prior nonadherence. Odds of graft failure increased sevenfold in nonadherent vs adherent recipients (95% CI reported as '4%-12%' in the abstract, presumably 4-12-fold).
- Absolute risks
Median 36% of graft losses associated with prior nonadherence
- Authors' conclusion
Nonadherence is common and has a large impact on transplant survival.
6. Strengths
- Systematic search
- Quantitative synthesis
7. Weaknesses
- Adherence measurement mostly self-report
- Older studies
- Abstract only read
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Measurement heterogeneity; observational data.
9. Assessment of the statistical interpretation
Large, consistent association; observational, but complete stopping of immunosuppression cannot ethically be randomised.
10. Relevance to the specific claim
Directly contradicts the idea that stopping immunosuppression is safe for a transplanted kidney.
11. Independent contrary findings
Rare 'operationally tolerant' patients exist (general transplant knowledge, not sourced here).
12. Transferability to Germany and Europe
High; same immunology.
13. Overall methodological judgement
Strong evidence that not taking immunosuppressants leads to graft loss.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Threshold of adherence that matters.