Rates and Risk Factors for Nonadherence to the Medical Regimen After Adult Solid Organ Transplantation

Abstract

The estimated nonadherence rates, overall and by transplant type, allow clinicians to gauge patient risk and target resources accordingly. Nonadherence rates in some areas--including immunosuppressant use--appear unacceptably high. Weak correlations of most patient psychosocial factors with nonadherence suggest that attention should focus on other classes of variables (e.g., provider-related and systems-level factors), which may be more influential.

Heart transplant centers with multidisciplinary team show a higher level of chronic illness management – Findings from the International BRIGHT Study

“…For instance, psychosocial problems like depression 20,21 and unemployment 22,23 are common in the HTx population, as well as behavioral issues such as non-adherence to different aspects of the therapeutic regimen. 24 Nurses, psychiatrists, psychologists, and social workers have the necessary training and knowledge to address these psychosocial needs; hence, having them in the team would logically result in higher level of CIM yet it is finally the model of care implemented and the intervention applied by the various involved disciplines that will determine optimal interplay of professionals to achieve favorable posttransplant outcomes. The positive association between multidisciplinarity and level of CIM that we found is consistent with previous research in other chronic illness populations.…”

Desirability and feasibility of wireless electronic monitoring of medications in clinical trials

“…The critical importance of adherence to immunosuppressant regimens in solid organ transplants makes it essential that organ recipients follow their regimens. Despite the role of adherence in optimizing clinical outcomes, Dew et al's [7] meta-analysis of posttransplant adherence in 32 studies noted mean NA for kidney recipients of 35.6 %, exceeding NA for heart (14.5 %) and liver (6.7 %) recipients. Also, despite medications' centrality to optimizing outcomes, NA in kidney recipients was higher than NA for nine other health behaviors (e.g., diet, exercise, clinic appointment attendance).…”

Lung Transplantation for Cystic Fibrosis

“…Key findings were reassuring. During any given year most transplant recipients are adherent (77,79). Over time, nonadherence increases, and a sizable proportion of recipients ultimately become nonadherent (79).…”

“…A meta-analysis reviewed nonadherence in 147 studies of solid organ transplantation (77). Average nonadherence rates were calculated for 10 areas of the medical regimen.…”

“…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).…”