Adherence to immunosuppression in adult lung transplant recipients: Prevalence and risk factors

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• 作者：Otto H. Bosma RN ; MSc^a ;   ; ^{o.h.bosma@long.umcg.nl} ; Karin M. Vermeulen PhD^b ; Erik A. Verschuuren MD ; PhD^a ; Michiel E. Erasmus MD ; PhD^c ; Wim van der Bij MD ; PhD^a
• 关键词：adherence ; immunosuppression ; lung transplantation ; electronic monitoring ; risk factors
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：2011
• 出版时间：November 2011
• 年：2011
• 卷：30
• 期：11
• 页码：1275-1280
• 全文大小：588 K

文摘

Background

Adherence to medication is a favourable with regard to survival after kidney, heart and liver transplantation. Little is known about adherence to medication in lung transplant recipients. To determine the prevalence of adherence and identify risk factors of non-adherence (NA) we evaluated adherence to tacrolimus in adult lung transplant recipients who were at least 1 year after transplantation.

Methods

Tacrolimus intake was prospectively monitored using the Medication Event Monitoring System (MEMS). Recipients qualified as adherent if a timing-adherence score of ?0 % was reached. Patients' characteristics and possible risk factors for NA were collected using the Karnofsky Performance Index, Self-Care Agency ASA Scale, State¨CTrait Anxiety Inventory, Zung Self-Rating Depression Scale, and the Long-Term Medication Behavior Self-Efficacy Scale.

Results

Ninety-one recipients used MEMS for a median of 95 days (range 50 to 124 days) and were included. They showed a median timing-adherence score of 98.1 % (range 31.2 % to 100 % ). A timing-adherence score of ?0 % was seen in 92.3 % of the recipients. Multiple logistic regression showed an association of lower timing-adherence scores with younger age and lower ability of self-care.

Conclusions

Adherence to immunosuppressive therapy was very high in lung transplant recipients. Only 7.7 % of the recipients were non-adherent. Younger recipients and recipients with lower ability of self-care appeared to be at risk for NA. Follow-up of clinical data is needed to determine whether NA is associated with poorer outcome, specifically bronchiolitis obliterans syndrome.