Cheng C-Y, Lin B Y-J, Chang K-H, Shu K-H, Wu M-J
Department of Pharmacy, Taichung Veterans General Hospital, Taichung, Taiwan.
Transplant Proc. 2012 Apr;44(3):746-8. doi: 10.1016/j.transproceed.2011.11.030.
Nonadherence to immunosuppressive drugs is a concern among kidney transplantation recipients (KTRs). The adverse effects of immunosuppressive drugs can trigger nonadherence and lead to a great impact on the allograft survival. The aim of this prospective controlled study is to determine the major adverse effects of immunosuppressive drugs and their correlation with the nonadherence in kidney transplantation recipients.
All data were collected from medical and pharmacy records. We use modified Immunosuppressant Therapy Adherence Scale combined with Modified Transplant Symptom Occurrence and Symptom Distress scale to explore the relationship between symptom experience related to side effects of immunosuppressants and adherence. The risk of nonadherence was estimated by stepwise logistic regression while controlling for age, gender, education, and immunosuppressive medications. Multivariable analysis was performed using a single random effect of P < .2.
In total, 412 KTRs completed the structured self-report instrument. The weekly pill counts were 84.2 ± 39.8. Overall, 21.4% of patients were nonadherent to immunosuppressive drugs. The most common adverse effects of immunosuppressive drugs were memory impairment (28.4%), insomnia (26.0%), gastrointestinal discomfort (21.4%), easy fatigue (22.1%), hand tremor (23.8%), and vision variation (29.1%). Multivariate analysis revealed that the adherence increased in patients with awareness of memory impairment (odds ratio 2.320, 95% confidence interval: 1.259-4.274, P = .007). There was no significant difference in the incidence of acute rejection, gender, age, and education between adherent and nonadherent patients.
In summary, these results indicate a significant prevalence of nonadherence to immunosuppressive drugs in kidney transplantation recipients. Awareness of memory impairment significantly affected adherence to immunosuppressive drugs.
肾移植受者（KTRs）中不依从免疫抑制药物治疗是一个令人担忧的问题。免疫抑制药物的不良反应可引发不依从，并对移植肾存活产生重大影响。这项前瞻性对照研究的目的是确定免疫抑制药物的主要不良反应及其与肾移植受者不依从性的相关性。
所有数据均从医疗和药房记录中收集。我们使用改良的免疫抑制治疗依从性量表，结合改良的移植症状发生和症状困扰量表，来探讨与免疫抑制剂副作用相关的症状体验与依从性之间的关系。在控制年龄、性别、教育程度和免疫抑制药物的情况下，通过逐步逻辑回归估计不依从的风险。使用P < 0.2的单一随机效应进行多变量分析。
共有412名KTRs完成了结构化自我报告工具。每周服药次数为84.2 ± 39.8。总体而言，21.4%的患者不依从免疫抑制药物治疗。免疫抑制药物最常见的不良反应是记忆障碍（28.4%）、失眠（26.0%）、胃肠道不适（21.4%）、易疲劳（22.1%）、手部震颤（23.8%）和视力变化（29.1%）。多变量分析显示，意识到记忆障碍的患者依从性增加（比值比2.320，95%置信区间：1.259 - 4.274，P = 0.007）。依从和不依从患者在急性排斥反应发生率、性别、年龄和教育程度方面无显著差异。
总之，这些结果表明肾移植受者中不依从免疫抑制药物治疗的情况相当普遍。意识到记忆障碍显著影响免疫抑制药物的依从性。
