Department of Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, University Hospital, Newark, NJ 07101, USA.
Clin Transplant. 2012 Mar-Apr;26(2):328-35. doi: 10.1111/j.1399-0012.2011.01489.x. Epub 2011 Sep 29.
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.
器官移植后，坚持使用免疫抑制剂并遵循后续治疗方案对于实现长期效果至关重要。为了确定最容易出现不依从的患者，本横断面描述性研究探讨了肝移植受者免疫抑制剂治疗不依从的发生率和相关因素。邮寄的匿名问卷包括以下几个领域：（i）免疫抑制剂使用的障碍，（ii）免疫抑制剂知识，（iii）人口统计学，（iv）社会支持，（v）合并的医学病症，（vi）医疗保健控制源和其他信念。总体回复率为 49%（281/572）。分析在研究开始后 10 年内接受移植的患者数据，发现 50%（119/237）的受者或每 100 人年中有 9.2 人报告不依从。在移植后 2-5 年期间报告的不依从率最高（69/123，56%）。不依从率最高的免疫抑制剂使用者为：离婚（26/34，76%，p=0.0093）、有药物或酒精使用史（42/69，61%，p=0.0354）、有心理健康需求（50/84，60%，p=0.0336）、错过门诊预约（25/30，83%，p<0.0001）和未保存药物记录（71/122，58%，p=0.0168）。不依从医生预约的患者，不依从免疫抑制剂的可能性超过四倍半（OR 4.7，95%CI 1.5-14.7，p=0.008）。总之，我们的半数受访者报告不依从免疫抑制剂。确定的因素可能有助于临床医生评估患者的不依从风险并确定资源分配。
