Compliance/Adherence After Kidney Transplant, With or With Out Med-O-Wheel™.

Background: Adherence to the immunosuppressive drug regimen is critical to the outcome after an organ transplant. Patients need to take their prescribed medications and attend their appointments with the doctor. Based on previous studies in other European countries, the cost of non-compliance after organ transplantation in Sweden is \>SEK 35 million/year. Patients who lose their graft both lose quality of life and have decreased expected survival; moreover, retransplantation may be hampered by new HLA antibodies. Question: The primary question is whether Med-O-Wheel™ can improve compliance to the prescribed medication regimen in renal transplant patients. Methods and materials: All kidney transplant patients at Karolinska University Hospital, Huddinge, will be given information about the study and will then be asked to participate. Participants will be randomized into two arms, one arm with and one with out Med-O-Wheel™. The 80 included patients will be closely monitored for 1 year regarding intake of prescribed medications. Med-O-Wheel™ is an electronic medication dispenser that records the date and time of each occasion when the patient takes medications from the dispenser. It has a SIM card and text messaging capabilities. Addoz Portal™ is a web-based application that makes it possible to monitor and analyse medication intake. Each event in the medication dispenser is registered in the portal, which communicates with the care provider/support person by text message, e-mail or telephone. Significance of the study: In the future it may be possible to improve compliance in transplant patients. In particular, patients will feel secure since they will receive confirmation through the portal that they are taking their medications safely and accurately.

Study objectives: To investigate whether Med-O-Wheel™ can improve - 1. adherence to medication regimens, 2. adherence to appointments at the outpatient clinic, and 3. treatment outcome in renal transplant patients. Methodology Study design: Open, prospective, descriptive, randomized study. Primary research question: Can Med-O-Wheel™ improve adherence to the prescribed medication regimen in renal transplant patients? Efficacy parameters: P-Creatinine, concentrations of medication (B-tacrolimus, B-cyclosporine, B-sirolimus, P/S-mycophenolate, B-TPMT-metabolites) and age(years). Addoz Portal for Med-O-Wheel™. Study-specific questionnaire to survey patient discomfort relating to compliance and adherence. Safety parameters: Med-O-Wheel™ and Addoz Portal™ is a CE-approved product with a guarantee for continuous operation. Karolinska University Laboratory is an accredited testing laboratory. Volunteer population Subjects: All patients about to undergo renal transplantation at Karolinska University Hospital. Number: 80 patients (40 patients with Med-O-Wheel™, 40 patients with out Med-O-Wheel™). Time frame First patient included: Juni 2011. Last patient included: Juli 2012. Last patient completed: Juli 2013.