Adherence to immunosuppressive therapy following liver transplantation: an integrative review

Abstract

Objective: to investigate the evidence available in the literature on non-adherence to immunosuppressive therapy among patients undergoing liver transplantation. Method: integrative literature review, including research whose sample consisted of patients aged over 18 years undergoing liver transplantation. It excluded those containing patients undergoing multiple organ transplants. For the selection of articles, Medline / Pubmed, CINAHL, LILACS, Scopus and Embase were searched. The search period corresponded to the initial date of indexation of different bases, up to the deadline of February 10, 2015, using controlled and uncontrolled descriptors: liver transplantation, hepatic transplantation, liver orthotopic transplantation, medication adherence, medication non-adherence, medication compliance and patient compliance. Results: were located 191 investigations, 10 of which met the objectives of the study and were grouped into four categories, namely: educational process and non-adherence; non-adherence related to the number of daily doses of immunosuppressive medications; detection methods for non-adherence and side effects of therapy. Conclusion: there were risk factors related to the health service, such as control and reduction of the number of doses; related to the individual, such as being male, divorced, alcohol or other substances user, exposed to low social support and being mentally ill.

Mensuração da não-adesão aos medicamentos imunossupressores em receptores de transplante de fígado

“…Results showing a correlation between fewer daily doses and protective factors for NA are in accordance with other studies. An integrative review (13) compiling risk factors for non-adherence to immunosuppressive medications in adult patients submitted to liver transplantation showed that a decrease in dosage for single daily doses is related to a lower rate of NA, due to adherence difficulties caused by concomitant use of combined medications. As an intervention proposal, we suggested a change in dosage from two daily doses to a single daily dose.…”

“…It is considered a multi-dimension phenomenon determined by the interaction of multiple factors, such as the patient's healthcare system, their socio-economic level, modality of provided treatment, the patient's medical condition, and underlying disease. (13) Patients are considered compliant to pharmaceutical management upon using 80% to 110% of the prescription medication. (14) In the setting of transplantation, NA is estimated to vary from 2% to 67%, with an annual average around 35.6%, (5,10) which results in graft rejection or failure, increased treatment costs, and morbimortality.…”

“…(14) In the setting of transplantation, NA is estimated to vary from 2% to 67%, with an annual average around 35.6%, (5,10) which results in graft rejection or failure, increased treatment costs, and morbimortality. (13,15,16) Studies show different strategies to identify NA, among them counting tablets, applying self-reported questionnaires, reporting side-effects of immunosuppressive (IMS) therapy, laboratory analysis of IMS serum levels, and electronic monitoring. (13,(14)(15)(16)(17)(18) However, self-reporting is the most common form of assessing NA, which has been shown to be useful in medical practice, easily applied, and of low cost.…”

“…(13,15,16) Studies show different strategies to identify NA, among them counting tablets, applying self-reported questionnaires, reporting side-effects of immunosuppressive (IMS) therapy, laboratory analysis of IMS serum levels, and electronic monitoring. (13,(14)(15)(16)(17)(18) However, self-reporting is the most common form of assessing NA, which has been shown to be useful in medical practice, easily applied, and of low cost. This method is moderately correlated to other measurement strategies and shows good capacity to predict medical outcomes.…”

“…Despite its poor sensitivity, self-reporting questionnaires are highly specific and can be combined with other strategies, yielding information on the patient's medication-use behavior. (13,19,20) In Brazil, studies of NA during post-transplantation follow-up are still in their early stages. Lack of data on this issue's actual dimensions makes implementing public policies focused on improvement of LT-and treatment-adherence-related clinical outcomes a difficult task.…”