Gastroenterology, Multivisceral Transplant Unit, Department of Surgical and Gastroenterological Sciences, University of Padua, Padua, Italy.
Liver Transpl. 2011 Jul;17(7):760-70. doi: 10.1002/lt.22294.
Adherence to a medical regimen has been defined as the extent to which a patient's behavior coincides with clinical prescriptions. In liver transplant patients, adherence to immunosuppressive therapy and to medical indications in general is crucial for short- and long-term outcomes. Nonadherence to immunosuppression carries a risk of graft rejection and potential graft loss, whereas nonadherence to general medical indications (eg, avoiding alcohol intake and smoking after transplantation) may be associated with other complications such as de novo tumors and increasing health care costs. Among adult liver transplant patients, the rate of nonadherence to immunosuppressive drugs ranges from 15% to 40%, whereas the rate of nonadherence to clinical appointments ranges from 3% to 47%. The wide range of reported rates is due to different definitions of the term nonadherence and the variety of methods used to measure adherence in the medical literature. Nonadherence seems to be nearly 4 times higher in pediatric and adolescent patients versus adult transplant recipients. Several nonadherence risk factors, such as high medication costs, psychiatric disorders, the conviction that the medication is harmful, and side effects of immunosuppressive therapy, have been described among adult liver transplant patients. The risk factors for nonadherence in pediatric and adolescent liver transplant patients are psychological distress, the functional status of their families, and the impact of immunosuppressive side effects on their physical appearance. A single approach to promoting adherence to general medical prescriptions has been proved to be ineffectual, so a multidisciplinary strategy should be adopted to achieve significant improvements in this field. The aim of this review is to analyze the published literature on adherence in liver transplant patients with a particular focus on the reported prevalence and the identified risk factors. Patients have been split into 2 age groups (adults and children/adolescents) because the scale of the problem and the potential risk factors differ in the 2 groups.
遵医行为是指患者的行为与临床医嘱相符的程度。在肝移植患者中，遵医嘱进行免疫抑制治疗和一般医学治疗对于短期和长期结果至关重要。不遵医嘱进行免疫抑制治疗会增加移植物排斥和潜在移植物丢失的风险，而不遵医嘱进行一般医学治疗（如，在移植后避免饮酒和吸烟）可能会导致其他并发症，如新发肿瘤和增加医疗保健费用。在成年肝移植患者中，不遵医嘱使用免疫抑制药物的比例为 15%至 40%，而不遵医嘱进行临床预约的比例为 3%至 47%。报告的比率差异较大是由于对不遵医嘱这一术语的不同定义以及在医学文献中用于衡量遵医行为的方法多样性所致。在儿科和青少年患者中，不遵医嘱的比例比成年肝移植受者高近 4 倍。在成年肝移植患者中，已经描述了一些不遵医嘱的风险因素，如药物费用高、精神障碍、认为药物有害以及免疫抑制治疗的副作用。在儿科和青少年肝移植患者中，不遵医嘱的风险因素包括心理困扰、家庭功能状态以及免疫抑制副作用对其外貌的影响。实践证明，单一的促进遵医嘱行为的方法是无效的，因此应采取多学科策略，以在该领域取得显著改善。本综述的目的是分析肝移植患者遵医行为的文献，重点关注报告的流行率和确定的风险因素。将患者分为 2 个年龄组（成人和儿童/青少年），是因为这两个组别的问题规模和潜在风险因素不同。
