Michaud Laurent, Ludwig Gundula, Berney Sylvie, Rodrigues Stéphanie, Niquille Anne, Santschi Valérie, Favre Anne-Sophie, Lange Anne-Catherine, Michels Annemieke A, Vrijens Bernard, Bugnon Olivier, Pilon Nathalie, Pascual Manuel, Venetz Jean-Pierre, Stiefel Friedrich, Schneider Marie-Paule
Psychiatric Liaison Service, University Hospital of Lausanne (CHUV). Lausanne ( Switzerland ).
General Psychiatry Service, University Hospital of Lausanne (CHUV). Lausanne ( Switzerland ).
Pharm Pract (Granada). 2016 Oct-Dec;14(4):822. doi: 10.18549/PharmPract.2016.04.822. Epub 2016 Dec 15.
Lack of adherence to medication is a trigger of graft rejection in solid-organ transplant (SOT) recipients.
This exploratory study aimed to assess whether a biopsychosocial evaluation using the INTERMED instrument before transplantation could identify SOT recipients at risk of suboptimal post-transplantation adherence to immunosuppressant drugs. We hypothesized that complex patients (INTERMED>20) might have lower medication adherence than noncomplex patients (INTERMED≤20).
Each patient eligible for transplantation at the University Hospital of Lausanne, Switzerland, has to undergo a pre-transplantation psychiatric evaluation. In this context the patient was asked to participate in our study. The INTERMED was completed pre-transplantation, and adherence to immunosuppressive medication was monitored post-transplantation by electronic monitors for 12 months. The main outcome measure was the implementation and persistence to two calcineurin inhibitors, cyclosporine and tacrolimus, according to the dichotomized INTERMED score (>20 or ≤20).
Among the 50 SOT recipients who completed the INTERMED, 32 entered the study. The complex (N=11) and noncomplex patients (N=21) were similar in terms of age, sex and transplanted organ. Implementation was 94.2% in noncomplex patients versus 87.8% in complex patients (non-significant p-value). Five patients were lost to follow-up: one was non-persistent, and four refused electronic monitoring. Of the four patients who refused monitoring, two were complex and withdrew early, and two were noncomplex and withdrew later in the study.
Patients identified as complex pre-transplant by the INTERMED tended to deviate from their immunosuppressant regimen, but the findings were not statistically significant. Larger studies are needed to evaluate this association further, as well as the appropriateness of using a nonspecific biopsychosocial instrument such as INTERMED in highly morbid patients who have complex social and psychological characteristics.
在实体器官移植（SOT）受者中，不坚持服药是移植排斥反应的一个触发因素。
这项探索性研究旨在评估移植前使用INTERMED工具进行的生物心理社会评估是否能够识别出移植后免疫抑制药物依从性欠佳风险较高的SOT受者。我们假设复杂患者（INTERMED>20）的药物依从性可能低于非复杂患者（INTERMED≤20）。
瑞士洛桑大学医院每一位符合移植条件的患者都必须接受移植前的精神评估。在此背景下，邀请患者参与我们的研究。移植前完成INTERMED评估，移植后通过电子监测器对免疫抑制药物的依从性进行12个月的监测。主要结局指标是根据二分法的INTERMED评分（>20或≤20）来衡量对两种钙调神经磷酸酶抑制剂环孢素和他克莫司的使用及持续使用情况。
在完成INTERMED评估的50例SOT受者中，32例进入研究。复杂患者（n=11）和非复杂患者（n=21）在年龄、性别和移植器官方面相似。非复杂患者的药物使用比例为94.2%，而复杂患者为87.8%（p值无统计学意义）。5例患者失访：1例未持续用药，4例拒绝电子监测。在拒绝监测的4例患者中，2例为复杂患者且提前退出，2例为非复杂患者且在研究后期退出。
移植前被INTERMED评估为复杂的患者往往会偏离免疫抑制方案，但研究结果无统计学意义。需要开展更大规模的研究来进一步评估这种关联，以及在具有复杂社会和心理特征的高病情患者中使用INTERMED这种非特异性生物心理社会工具的适用性。
