Changes in Medication Adherence Across the Posttransplant Period in Pediatric Organ Transplant Recipients

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-10-10 DOI:10.1111/ctr.15442

Michael O. Killian, Callie W. Little, Sonnie E. Mayewski

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Abstract

Introduction

Limited research has explored immunosuppressant medication adherence over time in pediatric transplant patients, who often struggle with posttransplant regimen adherence, resulting in poor outcomes.

Methods

This study investigated the longitudinal growth in immunosuppressive medication levels following transplantation. Medication level variability index (MLVI) scores from tacrolimus blood levels of pediatric organ transplant recipients at a major medical center were analyzed. Linear mixed effect models (LMEM) assessed individual MLVI change trajectories and predictors of growth, exploring both linear and curvilinear growth patterns posttransplant.

Results

A sample of 181 patients with at least 4 years of MLVI data were analyzed. Growth curve modeling identified the cubic model as the best fit for the quarterly MLVI values, which significantly decreased within the first 2 years posttransplant before stabilizing. Gender significantly predicted MLVI change, with females showing greater MLVI decreases, while age at transplant did not significantly predict changes. Significant variation in MLVI among individual patients was found in all models.

Conclusions

The study demonstrated a significant decrease in MLVI values over time, indicating improved medication adherence in pediatric transplant patients, with females exhibiting more adherent growth patterns than males. Future research should aim to identify pediatric patients at high risk of nonadherence.

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小儿器官移植受者移植后用药依从性的变化

简介：对儿科移植患者长期服用免疫抑制剂的研究有限：对儿科移植患者长期坚持服用免疫抑制剂的研究有限，这些患者往往在移植后难以坚持用药，导致治疗效果不佳：本研究调查了移植后免疫抑制剂用药量的纵向增长情况。研究分析了一家大型医疗中心儿科器官移植受者他克莫司血药浓度的用药水平变异指数（MLVI）得分。线性混合效应模型（LMEM）评估了单个 MLVI 的变化轨迹和增长预测因素，探讨了移植后的线性和曲线增长模式：结果：分析了 181 例至少有 4 年 MLVI 数据的患者样本。生长曲线模型确定立方模型是最适合季度 MLVI 值的模型，MLVI 值在移植后头两年内显著下降，然后趋于稳定。性别在很大程度上预测了 MLVI 的变化，女性的 MLVI 下降幅度更大，而移植时的年龄并不能显著预测变化。在所有模型中都发现了患者个体间 MLVI 的显著差异：该研究表明，随着时间的推移，MLVI 值明显下降，这表明儿科移植患者的用药依从性有所改善，其中女性比男性表现出更依从的生长模式。未来的研究应着眼于识别不坚持用药的高风险儿科患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.