Su Gloria Chun-Wei, Greanya Erica D, Partovi Nilufar, Yoshida Eric M, Shapiro R Jean, Levy Robert D
Lower Mainland Pharmacy Services, Vancouver General Hospital, Vancouver, British Columbia, Canada.
Exp Clin Transplant. 2013 Dec;11(6):475-81. doi: 10.6002/ect.2013.0060.
We sought to determine and compare the prevalence of nonadherence in lung, kidney, and liver transplant recipients, and identify potential risk factors for nonadherence.
This cross-sectional, single-center, retrospective cohort study, evaluated 225 outpatient lung, kidney, and liver transplant recipients' adherence to immunosuppressant medication. Based on immunosuppressant dosages and dispensing records, medication possession ratio (days of medication supplied/actual days) and gaps in prescription refills (> 30-day lapse between expected depletion of supply and next refill) were used as surrogate markers in assessing adherence for 2 years. Patients were adherent to their immunosuppressant medication regimens if their medication possession ratio was ≥ 80%.
The mean age of the subjects was slightly greater than 50 years of age, and they were a median of 2.0, 1.3, and 1.1 years posttransplant at the start of data collection for lung, kidney, and liver recipients. Overall medication possession ratios were 95.4% ± 7.5%, 95.9% ± 7.6%, and 92.7% ± 12.3% in our lung, kidney, and liver recipients. Only 7.1% of patients had a medication possession ratio lower than 80%, which was the cutoff for nonadherence. No statistical analyses were performed to identify potential factors for nonadherence because of the small number of nonadherent patients.
Immunosuppressant medication adherence at our center was high for all 3 organ cohorts, as measured by a medication possession ratio of 80% or better. Further study is needed to evaluate immunosuppressant adherence over time after transplant, and confirm the clinical factors that optimize adherence in high-risk patients.
我们试图确定并比较肺、肾和肝移植受者中不依从的发生率，并识别不依从的潜在风险因素。
这项横断面、单中心、回顾性队列研究评估了225例肺、肾和肝移植门诊受者对免疫抑制药物的依从性。基于免疫抑制药物剂量和配药记录，用药持有率（供应药物天数/实际天数）和处方 refill 间隔（预期药物供应耗尽与下次 refill 之间间隔超过30天）被用作评估2年依从性的替代指标。如果患者的用药持有率≥80%，则认为他们依从免疫抑制药物治疗方案。
研究对象的平均年龄略大于50岁，在肺、肾和肝移植受者数据收集开始时，他们移植后的中位时间分别为2.0年、1.3年和1.1年。我们的肺、肾和肝移植受者的总体用药持有率分别为95.4%±7.5%、95.9%±7.6%和92.7%±12.3%。只有7.1%的患者用药持有率低于80%，这是不依从的临界值。由于不依从患者数量较少，未进行统计分析以识别不依从的潜在因素。
以80%或更高的用药持有率衡量，我们中心所有3个器官队列的免疫抑制药物依从性都很高。需要进一步研究以评估移植后随时间推移的免疫抑制药物依从性，并确认优化高危患者依从性的临床因素。
