Self‐reported non‐adherence to immune‐suppressant therapy in liver transplant recipients: demographic, interpersonal, and intrapersonal factors

Abstract

Adherence to immune suppressants and follow-up care regimen is important in achieving optimal long-term outcomes after organ transplantation. To identify patients most at risk for non-adherence, this cross-sectional, descriptive study explores the prevalence and correlates of non-adherence to immune-suppressant therapy among liver recipients. Anonymous questionnaires mailed consisted of the domains: (i) adherence barriers to immune suppressants, (ii) immune suppressants knowledge, (iii) demographics, (iv) social support, (v) medical co-morbidities, and (vi) healthcare locus of control and other beliefs. Overall response was 49% (281/572). Data analyzed for those transplanted within 10 yr of study reveal 50% (119/237) recipients or 9.2/100 person years reporting non-adherence. Non-adherence was reported highest in the 2-5 yr post-transplant phase (69/123, 56%). The highest immune-suppressant non-adherence rates were in recipients who are: divorced (26/34, 76%, p=0.0093), have a history of substance or alcohol use (42/69, 61%, p=0.0354), have mental health needs (50/84, 60%, p=0.0336), those who missed clinic appointments (25/30, 83%, p<0.0001), and did not maintain medication logs (71/122, 58%, p=0.0168). Respondents who were non-adherent with physician appointments were more than four and a half times as likely (OR 4.7, 95% CI 1.5-14.7, p=0.008) to be non-adherent with immune suppressants. In conclusion, half of our respondents report non-adherence to immune suppressants. Factors identified may assist clinicians to gauge patients' non-adherence risk and target resources.

Non-Adherence and Graft Failure in Adult Liver Transplant Recipients

“…This finding is consistent with high rates of self-reported non-adherence in transplant recipients [6,21]. In a single-center US study, 56 % of transplant recipients reported non-adherence within the 2-5 year post-transplant period [14]. Various international studies have reported rather low rates of non- adherence among liver transplant recipients [12], which may be attributed to differences in methodology and social factors (i.e., differences in access to medical care and medications in US vs. non-US health care systems).…”

“…These behaviors are commonly used in the clinical setting to predict adherence, and our study substantiates this practice. Missed office appointments has been shown to be correlated with IS therapy non-adherence, which was confirmed in this study [14]. Pre-transplant substance abuse and non-adherence were found to be significantly associated with post-transplant non-adherence as measured by chart evidence.…”

“…Among adults, various international studies have attempted to measure non-adherence to IS therapy using self-reported non-adherence [12] and electronic medication monitoring [13], with the majority of patients found to be adherent to IS therapy. This is in contrast to a US study that found half of liver transplant recipients reporting non-adherence to IS therapy [14]. Adult liver transplant recipients in the US remain an understudied population for whom we have minimal data regarding the causes and effects of non-adherence.…”

“…Pre-transplant substance abuse and non-adherence were found to be significantly associated with post-transplant non-adherence as measured by chart evidence. This finding has been substantiated by other studies using self-reported measures of non-adherence [14,17]. When using high SD tacrolimus levels as a measure of post-transplant non-adherence, pretransplant unemployment was significantly associated with non-adherence; however, this was not substantiated using other measurements of non-adherence.…”

“…In a cross-sectional study of kidney transplant recipients, a comparison was made between the diagnostic accuracy of various methods of measuring non-adherence including: electronic monitoring, immunosuppressant drug assay, patient self-report, and physician collateral report [27]. Individual measures of non-adherence were found to have poor sensitivity, whereas a composite adherence score compiled of nonadherence information from patient self-report, medical team collateral report, and drug assay had the highest sensitivity [6, 14,27]. This can be a difficult task in the clinical setting, and using drug variability as a measure of non-adherence may be a cost-effective and easy-to-use clinical tool that should be further evaluated for its diagnostic accuracy of non-adherence.…”