Kindem Ingvild Andrea, Åsberg Anders, Midtvedt Karsten, Bjerre Anna
Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
Department of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.
Pediatr Transplant. 2023 Nov;27(7):e14590. doi: 10.1111/petr.14590. Epub 2023 Aug 5.
Reliable methods to detect and reduce medication nonadherence in solid organ-transplanted (SOT) adolescents are warranted. We aimed to evaluate the feasibility of combining a medication-manager application (TusenTac®-app) with home-sampling of tacrolimus (Tac) in young SOT recipients.
Kidney and combined SOT recipients between 14 and 25 years were included. During an 8-week intervention period, the participants were instructed to use the transplant-specific, age-adapted TusenTac®-app daily and to perform weekly at-home Tac trough finger-prick microsampling. Microsample Tac concentrations were controlled against timed venous samples twice. Medication implementation and persistence adherence were measured with BAASIS© questionnaires, TusenTac®-registrations, Tac trough concentration coefficient of variation (CV%) and self-reporting by interview. For comparison, venous Tac trough CV% were obtained from the year before and after the short-term intervention.
Twenty-two recipients were included, two withdrawals, leaving 20; median age 17.9 (14.5-24.8) years, 12 females (60%). The participants registered their dosage intake 88% (1502/1703) of the expected times, and 90% (106/118) of the microsamples were obtained correctly. At inclusion, 11 recipients (55%) were nonadherent assessed with BAASIS© questionnaire, four of these (36%) turned adherent during the intervention period. At the end, 70% reported improved timing-adherence at the interview. There was no significant change in TacCV% from the year before to the year after the short-term intervention. Home-sampling was reliable and measured Tac concentrations accurately.
Home-monitoring, combining Tac finger-prick microsampling and a medication-manager app, is feasible in adolescent SOT recipients with 70% perceived improvement in medication timing-adherence. There were no significant long-term changes in TacCV% confirming the need for continuous use and individualized interventions.
需要可靠的方法来检测和减少实体器官移植（SOT）青少年的药物不依从性。我们旨在评估将药物管理应用程序（TusenTac®-app）与他克莫司（Tac）家庭采样相结合在年轻SOT受者中的可行性。
纳入14至25岁的肾移植和联合SOT受者。在为期8周的干预期内，指导参与者每天使用针对移植且适合年龄的TusenTac®-app，并每周进行一次在家的Tac谷浓度手指采血微量采样。微量采样的Tac浓度与定时静脉血样进行两次对照。使用BAASIS©问卷、TusenTac®记录、Tac谷浓度变异系数（CV%）和访谈自我报告来衡量药物实施情况和持续依从性。为作比较，从短期干预前后的年份获取静脉Tac谷CV%。
纳入22名受者，2人退出，剩余20人；中位年龄17.9（14.5 - 24.8）岁，12名女性（60%）。参与者记录了预期时间的88%（1502/1703）的剂量摄入，90%（106/118）的微量样本采集正确。纳入时，根据BAASIS©问卷评估，11名受者（55%）不依从，其中4名（36%）在干预期内转为依从。最后，70%的人在访谈中报告用药时间依从性有所改善。短期干预前后一年的TacCV%无显著变化。家庭采样可靠且能准确测量Tac浓度。
将Tac手指采血微量采样与药物管理应用程序相结合的家庭监测在青少年SOT受者中是可行的，70%的人认为用药时间依从性有所改善。TacCV%无显著长期变化，这证实了持续使用和个体化干预的必要性。
