Department of Medicine, Division of Nephrology, 625 THT, University of Alabama at Birmingham, 1530 Third Avenue South, Birmingham, AL 35294-0006, USA.
Clin J Am Soc Nephrol. 2010 Jul;5(7):1305-11. doi: 10.2215/CJN.07241009. Epub 2010 May 6.
Nonadherence of transplant recipients to prescribed medical regimens has been identified as a major cause of allograft failure. Although recent studies offer new insight into the clinical phenotypes of nonadherence, advances in defining risk factors and appropriate interventions have been limited because of variable definitions, inadequate clinical metrics, and the challenges associated with healthcare delivery. Significant nonadherence is estimated to occur in 22% of renal allograft recipients and may be a component of allograft loss in approximately 36% of patients. It is associated with increased incidence of rejection (acute and chronic) and, consequently, shortened renal allograft survival, requiring reinstitution of costly chronic renal replacement therapy with an incumbent effect on morbidity and mortality. The economic effect of nonadherence approaches similar magnitude. Identification of risk factors, coupled with measures that effectively address them, can have a positive effect at many levels--medically, socially, and economically. Further advances are likely to be dependent on improving interactions between patients and caregivers, broadening immunosuppressant availability, and newer therapeutics that move toward simpler regimens.
移植受者不遵守规定的医疗方案已被确定为移植物失功的主要原因。尽管最近的研究为不遵医行为的临床表型提供了新的见解,但由于定义不明确、临床指标不足以及与医疗保健提供相关的挑战,在确定风险因素和适当干预措施方面的进展有限。据估计,在 22%的肾移植受者中存在显著的不遵医行为,并且在大约 36%的患者中可能是移植物丢失的一个组成部分。它与排斥反应(急性和慢性)的发生率增加有关,因此导致肾移植存活率缩短,需要重新开始昂贵的慢性肾脏替代治疗,这对发病率和死亡率有不利影响。不遵医行为的经济影响也具有类似的重要性。确定风险因素,并采取有效措施加以解决,可以在医学、社会和经济等多个层面产生积极影响。进一步的进展可能取决于改善患者和护理人员之间的相互作用,扩大免疫抑制剂的可及性,以及朝着更简单方案发展的新型治疗方法。