Noncompliance with Post-Transplant Immunosuppression

Abstract

Two cases from an adolescent dialysis group are presented to illustrate the limitations of the generally used models of patient compliance and noncompliance with medical treatment. Understanding the noncompliance of these two young men required awareness of their psychological development and of the interpersonal matrix in which they lived. Their noncompliance was the result of a failure to master a transition from dependence to autonomy which probably could not have been predicted in advance, but which might have detected as it developed and might have been avoided through appropriate interventions with the patients and their families.

Psychological factors in end-stage renal disease: An emerging context for behavioral medicine research.

“…However, transplant patients are required to follow a strict immunosuppressive medication regimen, attend frequent clinic and laboratory appointments, and remain vigilant about physical changes that may signal organ rejection or infection. Patient nonadherence to the immunosuppressive regimen is believed to be an important contributor to renal graft rejection and failure (Armstrong & Weiner, 1981; De Geest et al, 1995; Didlake, Dreyfus, Kerman, Van Buren, & Kahan, 1988). One study indicated that 78% of cases of renal graft failure in the second year after transplant were believed to be due to nonadherence (Kiley, Lam, & Pollak, 1993).…”

Psychosocial recovery from adult kidney transplantation: a literature review

“…(1989 ) used compliance contracts for patients who were poorly adherent as a prerequisite for placing the patient on the waiting list for kidney transplant. However, there is evidence that patients who are adherent with dialysis can become non‐adherent post‐transplant ( Armstrong et al ., 1981 ; Armstrong & Weiner, 1982; Didlake et al ., 1988 ). Despite this, a recent survey of kidney transplant centres in the USA (response rate 81%: 147/182) found that 83% of centres used attendance at dialysis as an important indicator of adherence after transplantation ( Ramos et al ., 1994 ).…”

La adherencia terapéutica en el paciente trasplantado renal

“…13 , señalando una prevalencia del 2% de abandono voluntario de los inmunosupresores. Diversos estudios desarrollados en los años siguientes mostraron prevalencias de incumplimiento similares, oscilando entre el 2-4.7% en pacientes con distintos regímenes terapéuticos 14 . Sin embargo estudios más recientes han demostrado incrementos signifi cativos en la prevalencia, con cifras que oscilan entre el 18-20%, representando, en algunas series, la tercera causa de pérdida del injerto 15 .…”