Kaiser Tiffany E, Alloway Rita R
Division of Digestive Disease, University of Cincinnati, Cincinnati, OH.
Division of Nephrology, University of Cincinnati, Cincinnati, OH.
Clin Transpl. 2015;31:275-284.
Following solid organ transplant, complex, lifelong medication regimens are required to prevent allograft rejection. Estimates of medication nonadherence in transplant recipients vary and may be as high as 70%. Poor medication adherence post transplant has been recognized as a contributing factor to reduced outcomes, including rejection, graft loss, and survival. Despite the numerous identified approaches for adherence assessment, there remains no gold standard. Ongoing efforts to identify optimal immunosuppressant adherence monitoring and measuring tools in an attempt to identify at risk populations post transplantation continue; however, the link between this information and outcomes remains to be discovered. Future adherence studies within the transplant population should focus on developing surrogate markers of immunosuppressant therapy adequacy and exploring the association amongst this data, adherence interventions, and outcomes so that optimal strategies may be identified. Immunosuppressant adherence should not be assumed, and interventions aimed a priori will provide opportunities to derail the movement of negative health outcomes resulting from preventable causes.
实体器官移植后，需要复杂的终身药物治疗方案来预防移植排斥反应。移植受者药物治疗依从性的估计值各不相同，可能高达70%。移植后药物依从性差已被认为是导致包括排斥反应、移植物丢失和生存率降低等不良后果的一个因素。尽管有许多已确定的依从性评估方法，但仍没有金标准。目前仍在努力确定最佳的免疫抑制剂依从性监测和测量工具，以试图识别移植后的高危人群；然而，这些信息与结果之间的联系仍有待发现。未来针对移植人群的依从性研究应侧重于开发免疫抑制剂治疗充分性的替代标志物，并探索这些数据、依从性干预措施和结果之间的关联，以便确定最佳策略。不应假定免疫抑制剂的依从性，先验性的干预措施将为阻止由可预防原因导致的负面健康结果的发展提供机会。
