New research reports that liver transplant recipients with less
understanding of treatment information and improper use of medications
may be more likely to have trouble following the prescribed regimen.
According to the study published in Liver Transplantation,
a journal of the American Association for the Study of Liver Diseases
and the International Liver Transplantation Society, the patients’
non-adherence is linked to adverse clinical outcomes, such as organ
rejection or graft loss.
During the past 30 years, improvements in surgical
techniques and advances in immunosuppressive drug therapies have help
improve survival rates for those undergoing solid organ transplantation.
Medical evidence suggests the effectiveness of immunosuppressives may
be hindered by multidrug regimens that require strict adherence
overtime, with non-adherence responsible for close to 50% of late acute
rejections and 15% of graft losses in adults.
“This is the first study to investigate
medication-taking behavior and evaluate regimen adherence and its
clinical impact on liver transplant recipients,” explains Dr. Marina
Serper with the Hospital of the University of Pennsylvania in
Philadelphia. “It is important to understand how crucial self-care
behaviors, such as following treatment plans, could lead to
re-hospitalization, graft rejection, and infection if post-transplant
regimens are not followed.”
For this study, the team enrolled 105 patients who
underwent liver transplantation between 2011 and 2012 at two transplant
centers in Chicago, Illinois and Atlanta, Georgia. The majority of
study participants were middle-aged men, with 15% of the group having
limited literacy. The average number of medications used by patients
was 11, with 39% of the group having had a change in medication within
the last month.
Results show that participants understood, on
average, 86% of their entire medication regimen, which translated to
knowing 90% of their immunosuppressive drug indications, 73% of
transplant medications (non-immunosuppressives), and 85% of medications
for chronic conditions. The score for demonstration of proper adherence
to the drug therapy regimen was 78% for all medications, 66% for
transplant immunosuppressive medications, 76% for transplant
non-immunosuppressives and 84% for chronic disease medications.
Self-reported non-adherence to the therapy regimen was 14% and based on
tacrolimus levels that number more than doubles to 32% of participants.
Lower income, less time since transplant, a higher
number of medications and limited literacy were associated with lower
treatment knowledge scores, and more medications and limited literacy
were linked to non-adherence to the regimen by tacrolimus levels. Dr.
Serper concludes, “Our findings indicate that higher scores for
treatment knowledge and demonstrated regimen use were independently
associated with reduced post-transplant re-hospitalization (15% and 13%,
respectively). By involving existing transplant center resources in
cost-effective interventions that help patients properly manage their
drug regimens, we could see an improvement in long term health of solid
organ transplant recipients.”
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“Medication Misuse, Non-Adherence, and Clinical Outcomes Among Liver
Transplant Recipients.” Marina Serper, Rachel E. Patzer, Peter P. Reese,
Kamila Przytula, Rachel Koval, Daniela P. Ladner, Josh M. Levitsky,
Michael M. Abecassis and Michael S. Wolf. Liver Transplantation; (DOI: 10.1002/lt.24023)
About the Journal
Liver Transplantation is published by Wiley on behalf of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.
Since the first application of liver transplantation in a clinical
situation was reported more than twenty years ago, there has been a
great deal of growth in this field and more is anticipated. As an
official publication of the AASLD and the ILTS,
Liver Transplantation delivers current, peer-reviewed articles on
surgical techniques, clinical investigations and drug research — the
information necessary to keep abreast of this evolving specialty. For
more information, please visit http://wileyonlinelibrary.com/journal/lt.
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Labels: adherence, literacy, liver transplant survival