Adherence to Posttransplantation Medical Regimen

DeckerMed Medicine Pub Date : 2018-09-19 DOI:10.2310/im.14060

Lauren S. Jones, M. Serper

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Abstract

In this review, we provide an overview of the most current evidence on the prevalence, risk factors, and consequences of medication non-adherence (NA) in liver transplant recipients. Despite the improvement in long-term liver transplantation outcomes, medication NA is the leading cause of graft failure, graft rejection, and poor clinical outcomes. We examine methods of measuring NA as well as interventions that have been carried out to improve medication adherence and posttransplantation outcomes. Common risk factors for NA include low social support, medication-related factors (eg. side effects), regimen complexity, younger age, financial barriers, and low literacy. Additionally, we discuss special at-risk populations with pretransplantation substance abuse or psychiatric comorbidities as well as adolescents making a transition into adulthood and independent self-care. Multifaceted interventions that are personalized and specific to identified adherence barriers for high-risk groups seem to be the most promising approach to improve medication NA and posttransplantation outcomes. This review contains 4 figures, 5 tables, and 53 references Key Words: electronic monitoring, immunosuppression, liver transplantation, medication, nonadherence, noncompliance, tacrolimus standard deviation, transplantation outcomes

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移植后医疗方案的依从性

在这篇综述中，我们提供了关于肝移植受者药物不依从性(NA)的患病率、危险因素和后果的最新证据的概述。尽管长期肝移植预后有所改善，但药物NA是导致移植物失败、移植物排斥反应和临床预后差的主要原因。我们研究了测量NA的方法以及为改善药物依从性和移植后结果而实施的干预措施。NA的常见危险因素包括低社会支持、药物相关因素(如:副作用)、治疗方案的复杂性、年龄更小、经济障碍和识字率低。此外，我们还讨论了移植前药物滥用或精神合并症的特殊高危人群，以及向成年过渡和独立自我照顾的青少年。针对高危人群的依从性障碍进行个性化和特异性的多方面干预似乎是改善药物NA和移植后结果的最有希望的方法。关键词:电子监测，免疫抑制，肝移植，药物治疗，不依从性，不依从性，他克莫司标准差，移植结局

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