Adherence to the Therapeutic Regimen in Heart, Lung, and Heart-Lung Transplant Recipients

Abstract

Optimal outcome after heart, lung, and heart-lung transplantation can only be obtained if patients are supported in adhering to a lifelong therapeutic regimen. The transplant patient's therapeutic regimen consists of a lifelong medication regimen, including immunosuppressive drugs; monitoring for signs and symptoms related to complications; avoidance of risk factors for cardiovascular disease and cancer (ie, diet and exercise prescriptions, nonsmoking); avoidance of abuse/dependence of alcohol or illegal drugs, as well as attending regular clinical checkups. Nonadherence to all aspects of this regimen is substantial. Nonadherence has been related to negative clinical outcome in view of acute rejections, graft vasculopathy, higher costs, and mortality. This review focuses on the prevalence, correlates, and consequences of nonadherence to the therapeutic regimen in heart, lung, and heart-lung transplantation. The current state of the-art on adherence-enhancing interventions is reported. Priorities for future research are outlined.

A Nurse-Led Self-Management Support Intervention (ZENN) for Kidney Transplant Recipients Using Intervention Mapping: Protocol for a Mixed-Methods Feasibility Study (Preprint)

“…Although findings indicate the importance of anticipating the individual needs of each patient to enhance effectiveness, most current interventions fail to do so [19,20,48]. It has been suggested that variance in effectiveness of SMS could be due to the mismatch between the individual's needs and the offered intervention [49].…”

“…Studies have shown that psychosocial (e.g. depression, anxiety) and behavioral factors could negatively affect self-management and are therefore important targets for SMS interventions [19,20,48,50].…”

Lung Transplantation for Cystic Fibrosis

“…Recently, a study of lung transplantation in children with CF failed to find systematic survival benefit in the United States (2). Nonadherence was not considered in that study, but it may play a role in the potential lack of survival benefit of lung transplantation in children (77)(78)(79)(80)(81).…”

“…Reported nonadherence varies from 1 to 10% of patients after transplantation for substance use (tobacco, alcohol, illicit drugs) to 19 to 25% for nonadherence to immunosuppressants (79). Nonadherence rates varied substantially depending on the type of organ transplanted (78). Nonadherence for immunosuppressants was highest in kidney recipients (77).…”

“…Other factors that potentially influence nonadherence after lung transplantation, such as patient-doctor relationship, mood fluctuations or depression, and negative attitudes and misperceptions regarding medication have not been thoroughly studied (77,78,85).…”