Medication nonadherence in liver transplantation

Whitsett, Maureen; Levitsky, Josh

doi:10.1002/cld.680

Cited by 7 publications

(8 citation statements)

References 24 publications

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“…This global improvement in graft failure and survival rates is most likely due to several factors, including either technological and surgical technique advancements or improvement in medical management and immunosuppressive therapy -it may not be necessarily due to improved medication adherence. (28)(29)(30)(31)(32)(33) Treatment for management of grafts consists of a combination of immunosuppressive agents with different mechanisms of action. This strategy minimizes morbidity and mortality individually associated to each immunosuppressive agent class, maximizing global treatment efficacy.…”

Section: Discussionmentioning

confidence: 99%

“…This intervention showed significant decrease in NA, stabilization of drug serum levels, and absence of liver, kidney, and heart complications. (13,(25)(26)(27)(28)(29)(30)(31)(32) Traditionally, when assessing NA in the setting of transplantation, one must correlate social and cultural factors to adherence findings. However, in this study, only one variable showed a certain level of relevance, marital status.…”

Section: Discussionmentioning

confidence: 99%

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Mensuração da não-adesão aos medicamentos imunossupressores em receptores de transplante de fígado

et al. 2019

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Objective: Assessing the level of non-adherence to immunosuppressive therapy in a sample of liver transplantation recipients using the Basel Assessment of Adherence with Immunosuppressive Medication Scale; correlating socio-demographic features and clinical factors to medication non-adherence. Methods: This cross-sectional epidemiological study was conducted between March 2016 and March 2018 at the outpatient service for liver transplantations of the Federal University of São Paulo. Results: Forty-nine patients were assessed. The level of medication non-adherence after liver transplantation was 49%. It was directly correlated to the use of mycophenolic acid (p=0.007) and to multiple daily dosing of immunosuppressant medication (p=0.004). No statistically signifi cant correlations were found between non-adherence to immunosuppressive therapy, socio-demographic features, and the remaining clinical variables assessed.Conclusion: This study shows that nearly half of all patients are not compliant with immunosuppressive therapy after liver transplantation. Given poor liver transplantation outcomes are intimately related to adherence failure, nurses need to assess this behavior in outpatient follow-up of liver transplantation recipients. ResumoObjetivo: Avaliar os níveis de não-adesão à terapia imunossupressora em uma amostra de receptores de transplante de fígado utilizando a Basel Assessment of Adherence with Immunosuppressive Medication Scale; correlacionar as características sociodemográfi cas e os fatores clínicos à não-adesão medicamentosa. Métodos: Estudo epidemiológico e transversal, realizado entre março 2016 e março 2018 no ambulatório de transplante de fígado da Universidade Federal de São Paulo. Resultados: Foram avaliados 49 pacientes. O nível de não-adesão medicamentosa no transplante de fígado foi de 49% e esteve diretamente relacionado ao uso do ácido micofenólico (p=0,007) e à administração de múltiplas doses de imunossupressores diariamente (p=0,004). Não foram encontradas correlações estatisticamente signifi cativas entre a não-adesão à terapia imunossupressora e as características sociodemográfi cas e demais variáveis clínicas analisadas. Conclusão: Este estudo mostrou que quase a metade dos pacientes deixaram de aderir à terapia imunossupressora no pós transplante de fígado. Uma vez que os desfechos desfavoráveis no transplante estão intimamente relacionados à falhas na adesão, é importante os enfermeiros avaliarem esse comportamento durante o seguimento ambulatorial dos receptores de transplante de fígado. ResumenObjetivo: Analizar los niveles de no adhesión a la terapia inmunosupresora en una muestra de receptores de trasplante de hígado utilizando la Basel Assessment of Adherence with Immunosuppressive Medication Scale y correlacionar las características sociodemográfi cas y los factores clínicos con la no adhesión a los medicamentos. Métodos: Estudio epidemiológico y transversal realizado entre marzo de 2016 y marzo de 2018 en los consultorios externos de trasplante de hígado de la Universidad ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mensuração da não-adesão aos medicamentos imunossupressores em receptores de transplante de fígado

et al. 2019

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“…using pill bottles with a special cap that contains microelectronics to register the time and date of every bottle opening) yields detailed and reliable data but it is time- and cost-consuming[ 133 ]. There is also debate for its use as a gold standard, since it may not be feasible in clinical practice[ 134 , 135 ]. Trough levels can be affected by a variety of conditions, such as graft function and the concomitant use of other drugs[ 136 ].…”

Section: Maintenance Immunosuppression and Adherence To Therapymentioning

confidence: 99%

Main factors influencing long-term outcomes of liver transplantation in 2022

Fuochi¹,

Anastasio²,

Lynch³

et al. 2023

World J Hepatol

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Liver transplant (LT) outcomes have markedly improved in the recent decades, even if long-term morbidity and mortality are still considerable. Most of late deaths are independent from graft function and different comorbidities, including complications of metabolic syndrome and de novo neoplasms, seem to play a key role in determining long-term outcomes in LT recipients. This review discusses the main factors associated with late mortality and suggests possible strategies to improve long-term management and follow-up after liver transplantation. In particular, the reduction of drug toxicity, the use of tools to identify high-risk patients, and setting up a multidisciplinary team also for long-term management of LT recipients may further improve survival after liver transplantation.

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“…Liver transplant recipients (LTRs) are required to take immunosuppressive medications throughout their life. Nonadherence is common and is variable over time [ 1 ]. It is estimated that roughly 20–62% of adults and about 50% of pediatric LTR are nonadherent to their immunosuppressive medication regimen [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Nonadherence is common and is variable over time [ 1 ]. It is estimated that roughly 20–62% of adults and about 50% of pediatric LTR are nonadherent to their immunosuppressive medication regimen [ 1 , 2 ]. The most serious outcomes of immunosuppression nonadherence (IMNA) include acute/chronic graft rejection and death.…”

Section: Introductionmentioning

confidence: 99%

Improved Medication Adherence with the Use of Extended-Release Tacrolimus in Liver Transplant Recipients: A Pilot Randomized Controlled Trial

Zaki

Sadeh

Knorr

et al. 2023

Journal of Transplantation

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Background. Nonadherence to immunosuppression in liver transplant recipients (LTRs) leads to deterioration in health outcomes. Once-dailyextended-release tacrolimus (TAC-ER) may improve adherence when compared to twice-dailyimmediate-release tacrolimus (TAC-IR). Methods. We conducted a randomized controlled study to evaluate medication adherence, clinical efficacy, and safety of TAC-ER in stable LTR. All patients >18 years who underwent liver transplantation before 6 months were eligible. Patients were randomized 1 : 1 to continued TAC-IR or conversion to TAC-ER. The primary outcome was change in medication adherence from baseline to 9 months, assessed using BAASIS. Secondary outcomes were tacrolimus trough levels, safety, and quality of life. Results. Thirty-one patients were consented and randomized to either of the two groups: conversion to TAC-ER (n = 15) or continued TAC-IR (n = 16). Six patients in the TAC-ER group withdrew after randomization due to apprehension about switching medication (n = 2), unwillingness to travel (n = 2), and increased liver tests after conversion (n = 2, both were acute rejections despite therapeutic tacrolimus levels and were considered unrelated to TAC-ER). We compared the results of nine patients in the TAC-ER group that completed the study with those of sixteen in the TAC-IR group. At baseline, there was no difference in tacrolimus trough levels between groups. Improved adherence was observed in the TAC-ER group as 100% of patients reported at least one period of full adherence during the study period (100% vs. 62.6%, p = 0.035 ). Tacrolimus trough levels and liver tests were comparable between groups throughout the study. There were no differences in eGFR, HbA1c, or QoL between the groups. Conclusion. TAC-ER improved medication adherence while maintaining comparable trough levels, liver function, and QoL as TAC-IR in LTR.

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Medication nonadherence in liver transplantation

Abstract: http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/10-6-reading-whitsett.html a video presentation of this article http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/10-6-interview-whitsett.html the interview with the author

Cited by 7 publications

References 24 publications

Mensuração da não-adesão aos medicamentos imunossupressores em receptores de transplante de fígado

Mensuração da não-adesão aos medicamentos imunossupressores em receptores de transplante de fígado

Main factors influencing long-term outcomes of liver transplantation in 2022

Improved Medication Adherence with the Use of Extended-Release Tacrolimus in Liver Transplant Recipients: A Pilot Randomized Controlled Trial

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