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

Abstract

Objective: Assessing the level of non-adherence to immunosuppressive therapy in a sample of liver transplantation recipients using the Basel Assessment of Adherence with Immunosuppressive Medication Scale; correlating socio-demographic features and clinical factors to medication non-adherence. Methods: This cross-sectional epidemiological study was conducted between March 2016 and March 2018 at the outpatient service for liver transplantations of the Federal University of São Paulo. Results: Forty-nine patients were assessed. The level of medication non-adherence after liver transplantation was 49%. It was directly correlated to the use of mycophenolic acid (p=0.007) and to multiple daily dosing of immunosuppressant medication (p=0.004). No statistically signifi cant correlations were found between non-adherence to immunosuppressive therapy, socio-demographic features, and the remaining clinical variables assessed.Conclusion: This study shows that nearly half of all patients are not compliant with immunosuppressive therapy after liver transplantation. Given poor liver transplantation outcomes are intimately related to adherence failure, nurses need to assess this behavior in outpatient follow-up of liver transplantation recipients. ResumoObjetivo: Avaliar os níveis de não-adesão à terapia imunossupressora em uma amostra de receptores de transplante de fígado utilizando a Basel Assessment of Adherence with Immunosuppressive Medication Scale; correlacionar as características sociodemográfi cas e os fatores clínicos à não-adesão medicamentosa. Métodos: Estudo epidemiológico e transversal, realizado entre março 2016 e março 2018 no ambulatório de transplante de fígado da Universidade Federal de São Paulo. Resultados: Foram avaliados 49 pacientes. O nível de não-adesão medicamentosa no transplante de fígado foi de 49% e esteve diretamente relacionado ao uso do ácido micofenólico (p=0,007) e à administração de múltiplas doses de imunossupressores diariamente (p=0,004). Não foram encontradas correlações estatisticamente signifi cativas entre a não-adesão à terapia imunossupressora e as características sociodemográfi cas e demais variáveis clínicas analisadas. Conclusão: Este estudo mostrou que quase a metade dos pacientes deixaram de aderir à terapia imunossupressora no pós transplante de fígado. Uma vez que os desfechos desfavoráveis no transplante estão intimamente relacionados à falhas na adesão, é importante os enfermeiros avaliarem esse comportamento durante o seguimento ambulatorial dos receptores de transplante de fígado. ResumenObjetivo: Analizar los niveles de no adhesión a la terapia inmunosupresora en una muestra de receptores de trasplante de hígado utilizando la Basel Assessment of Adherence with Immunosuppressive Medication Scale y correlacionar las características sociodemográfi cas y los factores clínicos con la no adhesión a los medicamentos. Métodos: Estudio epidemiológico y transversal realizado entre marzo de 2016 y marzo de 2018 en los consultorios externos de trasplante de hígado de la Universidad ...

Perfil Epidemiológico de uma Amostra de Pacientes Submetidos ao Transplante de Órgão Hepático Residentes em Boa Vista - Roraima / Epidemiological Profile of a Sample of Patients Undergoing Liver Organ Transplantation Residents in Boa Vista – Roraima

“…Outrossim, pode ser uma causa direta de todos os insucessos de transplante bem como das taxas de mortalidade. Esses achados são consistentes com a literatura, pois segundo Oliveira et al (2019), em uma amostra com 49 pacientes, houve uma incorreta ou NA da terapia imunossupressora em 49%. Devido aos riscos de rejeição do enxerto, é fundamental a realização do acompanhamento ambulatorial, com o intuito de prevenir complicações que possam comprometer a sobrevida do enxerto.…”

Pharmaceutical care in immunosuppressive therapy for heart transplant patients in ceará

“…Similar data were presented by Oliveira et al, who evaluated adherence to immunosuppressants with the same instrument, indicating a rate of 49% of non-adherents and the same reason for non-compliance with drug prescriptions. 15 Failure to comply with immunosuppressive regimen schedules is frequently demonstrated in studies that assess adherence, with delays of 1.5hours and 2hours. The fact is that the literature proves that attitudes that produce delays in the administration of doses can change the dosages of immunosuppressants in the blood.…”

“…Small failures in adherence to the immunosuppressive regimen result in damage to the health of the organ. [16][17][18][19][20] It is worth mentioning that the CG for which there was no pharmaceutical care provided also showed a gain in adherence to immunosuppressive therapy. The researchers assume that this finding, although not statistically significant, was influenced by the close contact that the two groups had with each other, as the discovery of the information generated new learning that they themselves started to disseminate, making the information offered to the IG participants, to be shared with CG participants.…”

Economic Impact of Pharmaceutical Recommendations Carried Out in a Liver Transplant Unit of a University Hospital

“…The success of the transplant is directly linked to the patient's commitment to their treatment. Patients are at inherent risk of rejection, requiring them to undergo immunosuppressive therapy and be monitored for signs of rejection 3 . Furthermore, the transplant forces the patient to change lifestyle habits such as diet, hygiene, medications and health care 4 .…”