Danziger-Isakov Lara, Frazier Thomas W, Worley Sarah, Williams Nikki, Shellmer Diana, Dharnidharka Vikas R, Gupta Nitika A, Ikle David, Shemesh Eyal, Sweet Stuart C
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Cleveland Clinic Children's, Cleveland, Ohio.
Pediatr Transplant. 2019 May;23(3):e13361. doi: 10.1111/petr.13361. Epub 2019 Feb 12.
Perceived barriers to adherence have previously been investigated in SOT to identify plausible intervention targets to improve adherence and transplant outcomes. Fifteen centers in CTOTC enrolled patients longitudinally. Patients >8 years completed Adolescent Scale(AMBS) at two visits at least 6 months apart in the first 17 months post-transplant while their guardians completed PMBS. Differences over time for pre-identified AMBS/PMBS factors were analyzed. Perceived barrier reporting impact on subsequent TAC levels was assessed. A total of 123 patients or their guardians completed PMBS or AMBS. Twenty-six were 6-11 years and 97 were ≥12. The final cohort consisted of kidney (66%), lung (19%), liver (8%), and heart (7%) recipients. Unadjusted analysis showed no statistically significant change in reported barriers from visit 1 (median 2.6 months, range 1.2-3.7 post-transplant) to visit 2 (median 12, range 8.9-16.5). Of 102 patients with TAC levels, 74 had a single level reported at both visits. The factor of "Disease frustration" was identified through the PMBS/AMBS questions about fatigue around medication and disease. Each point increase in "disease frustration" at visit 1 on the AMBS/PMBS doubled the odds of a lower-than-threshold TAC level at visit 2. No clear change in overall level of perceived barriers to medication adherence in the first year post-transplant was seen in pediatric SOT. However, disease frustration early post-transplant was associated with a single subtherapeutic TAC levels at 12 months. A brief screening measure may allow for early self-identification of risk.
以往在实体器官移植（SOT）中对感知到的依从性障碍进行了调查，以确定合理的干预靶点，从而提高依从性和移植结局。儿童移植协作研究组（CTOTC）的15个中心对患者进行了纵向研究。年龄大于8岁的患者在移植后的前17个月内，至少间隔6个月进行两次青少年量表（AMBS）评估，而他们的监护人则完成家长量表（PMBS）评估。分析预先确定的AMBS/PMBS因素随时间的差异。评估感知到的障碍报告对随后他克莫司（TAC）水平的影响。共有123名患者或其监护人完成了PMBS或AMBS评估。其中26名患者年龄在6 - 11岁，97名患者年龄≥12岁。最终队列包括肾移植受者（66%）、肺移植受者（19%）、肝移植受者（8%）和心脏移植受者（7%）。未调整分析显示，从第1次访视（移植后中位数2.6个月，范围1.2 - 3.7个月）到第2次访视（中位数12个月，范围8.9 - 16.5个月），报告的障碍无统计学显著变化。在102名有TAC水平数据的患者中，74名患者在两次访视中均报告了单一水平。通过PMBS/AMBS中关于服药和疾病相关疲劳的问题，确定了“疾病挫败感”这一因素。在AMBS/PMBS中，第1次访视时“疾病挫败感”每增加1分，第2次访视时TAC水平低于阈值的几率就会增加一倍。在小儿实体器官移植中，移植后第一年药物依从性的总体感知障碍水平未见明显变化。然而，移植后早期的疾病挫败感与12个月时单一的低于治疗剂量的TAC水平相关。一种简短的筛查措施可能有助于早期自我识别风险。
