Hilbrands L B, Hoitsma A J, Koene R A
Department of Medicine, University Hospital Nijmegen, The Netherlands.
Transplantation. 1995 Nov 15;60(9):914-20.
Noncompliance is known to be an important cause of late graft failure after renal transplantation. We investigated prospectively the degree of compliance with immunosuppressive and antihypertensive drugs during the first year after renal transplantation by monthly pill counts. In addition, we examined whether noncompliance was related to a number of demographic and clinical variables or to the occurrence of rejections. The study population consisted of 127 patients who were involved in a randomized trial comparing cyclosporine monotherapy with azathioprine-prednisone treatment. Average compliance rates approximated 100%, although considerable variability within and between subjects was observed. Using an arbitrary limit to classify patients as compliers or noncompliers, the following frequencies of noncompliance were observed during the study year: cyclosporine, 23%; azathioprine, 13%; prednisone, 23%; atenolol, 36%; and nifedipine, 32%. Average compliance scores for all immunosuppressive drugs were superior to those of antihypertensive medication (P < 0.001). Except for a better compliance for prednisone in men as compared with women, we found no consistent relationship between compliance on the one hand and several demographic variables, graft function, or quality of life on the other hand. Patients who developed one or more acute rejection episodes showed a higher degree of undercompliance, especially for prednisone, than patients without rejections (P < 0.01). Following the occurrence of a rejection episode, compliance scores improved significantly. Keeping in mind the limitations of the pill count method, we conclude that noncompliance with immunosuppressive drugs is not a huge problem during the first year after renal transplantation. However, it is likely that noncompliance contributes to a certain number of acute rejection episodes.
众所周知，不依从是肾移植术后移植肾晚期失功的一个重要原因。我们通过每月清点药丸数量，前瞻性地调查了肾移植术后第一年患者对免疫抑制药物和降压药物的依从程度。此外，我们还研究了不依从是否与一些人口统计学和临床变量或排斥反应的发生有关。研究人群包括127名参与环孢素单药治疗与硫唑嘌呤 - 泼尼松治疗对比随机试验的患者。尽管观察到受试者内部和之间存在相当大的变异性，但平均依从率接近100%。使用一个任意界限将患者分类为依从者或不依从者，在研究年度观察到以下不依从频率：环孢素，23%；硫唑嘌呤，13%；泼尼松，23%；阿替洛尔，36%；硝苯地平，32%。所有免疫抑制药物的平均依从得分优于降压药物（P < 0.001）。除了男性对泼尼松的依从性优于女性外，我们发现一方面依从性与一些人口统计学变量、移植肾功能或生活质量之间没有一致的关系。发生一次或多次急性排斥反应的患者比未发生排斥反应的患者表现出更高程度的依从性不足，尤其是泼尼松（P < 0.01）。在排斥反应发作后，依从得分显著提高。考虑到药丸计数方法的局限性，我们得出结论，肾移植术后第一年不依从免疫抑制药物不是一个大问题。然而，不依从可能导致一定数量的急性排斥反应发作。
