Factors impacting the medication “Adherence Landscape” for transplant patients

Abstract

Background Medication non‐adherence contributes to post‐transplant graft rejection and failure; however, limited knowledge about the reasons for non‐adherence hinders the development of interventions to improve adherence. We conducted focus groups with solid organ transplant recipients regarding overlooked challenges in the process of transplant medication self‐management and examined their adherence strategies and perceptions towards the post‐transplant medication regimen. Methods We conducted four focus groups with n = 31 total adult transplant recipients. Participants had received kidney, liver, or combined liver/kidney transplant at Johns Hopkins Hospital between 2014 and 2019. Focus groups were audio‐recorded and transcribed. Transcripts were analyzed inductively, using the constant comparative method. Results Responses generally fell into two major categories: (1) barriers to adherence and (2) “adherence landscape”. We define the former as factors directly labeled as barriers to adherence by participants and the latter as factors that heavily influence the post‐transplant medication self‐management process. Conclusions We propose a shift in the way healthcare providers and researchers, address the question of medication non‐adherence. Rather than asking why patients are non‐adherent, we suggest that constructing and understanding patients’ “adherence landscape” will provide an optimal way to align the goals of patients and providers and boost health outcomes.

Multi‐phasic eGFR trajectory during follow up and long‐term graft failure after kidney transplantation

“…Raynaud, 11 in a large-scale study that included 14 132 patients eight trajectory patterns that were highly associated with clinical and histological predictors as well as graft outcome were found, by using latent class mixed model. It is important to note that kidney transplant recipients after long term stability may develop unexpected events affecting kidney function such as acute 12 or chronic rejection after medication nonadherence, 13 AKI, 14 or nephrotoxic effects of drugs. following events affecting kidney function, such as exposure to nephrotoxic drugs or medication non-adherence, we speculate changes in the trajectory of the kidney function during the long-term follow-up.…”