Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Stephen Marks, Great Ormond Street Hospital, UK
- Second opponent: Senior Consultant Rannveig Skrunes, Haukeland University Hospital
- Third member and chair of the evaluation committee: Associate Professor Are Martin Holm, University of Oslo
Chair of the Defence
Professor Emeritus Petter Gjersvik, University of Oslo
Principal Supervisor
Senior Consultant Karsten Midtvedt, Oslo University Hospital
Summary
Following organ transplantation life-long immunosuppressive therapy is mandatory. Medication nonadherence (“not taking medication as prescribed”) is one of the main reasons for graft loss during the transition phase from pediatric to adult care. The thesis elaborates on strategies for optimization of medication adherence, with focus on home-monitoring and investigates medication nonadherence and graft outcomes during the transition phase in Norway. We hypothesized that more patient-centered follow-up, adapted to the young, may improve immunosuppressive drug adherence, and potentially have impact on long-term outcomes.
In paper I Tacrolimus (Tac) (an immunosuppressive drug) concentrations obtained by a novel finger-prick microsampling technique was validated against concentrations in samples collected via standard venipuncture in pediatric solid organ recipients. Fifty-five comparable samples demonstrated good concordance.
Paper II is a retrospective cohort analysis of kidney transplantations performed in Norway from 2000-2020 comparing outcomes of recipients <26 years of age vs those 26-50 years of age. During the transition phase to adult care 58% of graft losses could be explained by medication nonadherence. Most of the investigated adverse events (acute rejections, antibodies developed against the transplanted kidney, graft loss) occurred shortly after transfer to adult care.
Paper III is a feasibility study of home-monitoring in 20 young recipients, combining a novel medication-manager application with home blood sampling of Tac. Self-management was preferred by all when compared to ordinary hospital consultations and 70% perceived improvement in medication timing-adherence.
The thesis elaborates on the negative impact medication nonadherence has on graft outcomes during the transition phase. Home-monitoring may contribute to optimalization of drug-monitoring and medication adherence among kidney transplanted adolescents and young adults.
Additional information
Contact the research support staff.