Lieb Marietta, Schiffer Mario, Erim Yesim
Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany.
Department of Nephrology and Hypertension, University Hospital of Erlangen, Erlangen, Germany.
Patient Prefer Adherence. 2020 Aug 5;14:1389-1401. doi: 10.2147/PPA.S258131. eCollection 2020.
Non-adherence (NA) after renal transplantation poses a major risk for allograft rejection, graft loss, and patient mortality. Yet, there is still ambiguity about its etiology and its possible relationships with patient-related factors. In order to prevent poor outcomes after transplantation, it is crucial to gain a more refined understanding of potential determinants, to identify patients at risk, and to intervene accordingly. The objective of this study was to assess potential risk factors of NA by prospectively applying electronic monitoring.
This was a single-center prospective observational study. Prior to study initiation, sociodemographic, biomedical, and psychosocial variables (depression, health-related quality of life, self-efficacy, social support, attachment, experiences and attitudes towards immunosuppressive medication, emotional responses after organ transplantation, satisfaction with information about immunosuppressive medication, and perceptions and beliefs about medications) were assessed. Thereafter, immunosuppressive adherence behavior was measured prospectively via electronic monitoring (EM, VAICA©) during a 3-month period to receive the percentage frequency of Taking and Timing Adherence (±2h, ±30min) for each patient. Focus of this study was the phase of medication implementation.
A total of 78 patients participated in our study (mean age 55.28, 56% male). We found rates of 99.39% for Taking Adherence, 98.34% for Timing Adherence ±2h, and 93.34% for Timing Adherence ±30min, respectively. Multiple regression analyses revealed that the type of medication could significantly predict Taking Adherence. Patients receiving Advagraf© (once daily) depicted better Taking Adherence than patients receiving Prograf© (twice daily) (p=0.04). No associations were found for Timing Adherence (±2h, ±30min). Sociodemographic, biomedical, or psychosocial variables were not found to be associated with adherence behavior.
In highly adherent populations, only a few factors can be altered to improve adherence. Changing the immunosuppressive regimen from twice-daily to once-daily could be an option for optimizing adherence. However, risk factors for NA could be different in a less adherent population.
肾移植后的不依从性（NA）是同种异体移植排斥、移植失败和患者死亡的主要风险因素。然而，其病因以及与患者相关因素之间可能存在的关系仍不明确。为防止移植后出现不良后果，更深入地了解潜在决定因素、识别有风险的患者并进行相应干预至关重要。本研究的目的是通过前瞻性地应用电子监测来评估NA的潜在风险因素。
这是一项单中心前瞻性观察性研究。在研究开始前，评估了社会人口统计学、生物医学和心理社会变量（抑郁、健康相关生活质量、自我效能感、社会支持、依恋、对免疫抑制药物的体验和态度、器官移植后的情绪反应、对免疫抑制药物信息的满意度以及对药物的认知和信念）。此后，在3个月期间通过电子监测（EM，VAICA©）前瞻性地测量免疫抑制依从行为，以获取每位患者的服药依从率和服药时间依从率（±2小时，±30分钟）。本研究的重点是药物治疗实施阶段。
共有78名患者参与了我们的研究（平均年龄55.28岁，56%为男性）。我们发现服药依从率为99.39%，服药时间依从率±2小时为98.34%，服药时间依从率±30分钟为93.34%。多元回归分析显示，药物类型可显著预测服药依从性。接受Advagraf©（每日一次）的患者服药依从性优于接受Prograf©（每日两次）的患者（p=0.04）。未发现服药时间依从性（±2小时，±30分钟）与其他因素有关。未发现社会人口统计学、生物医学或心理社会变量与依从行为有关。
在高度依从的人群中，只有少数因素可以改变以提高依从性。将免疫抑制方案从每日两次改为每日一次可能是优化依从性的一种选择。然而，在依从性较低的人群中，NA的风险因素可能不同。
