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. 2018 Jun;5(2):174-188.
doi: 10.1007/s40472-018-0195-8. Epub 2018 Apr 17.

Posttransplant Medical Adherence: What Have We Learned and Can We Do Better?

Mary Amanda Dew  1   2 , Donna M Posluszny  3 , Andrea F DiMartini  4 , Larissa Myaskovsky  5 , Jennifer L Steel  6 , Annette J DeVito Dabbs  7
Affiliations

Posttransplant Medical Adherence: What Have We Learned and Can We Do Better?

Mary Amanda Dew et al. Curr Transplant Rep. 2018 Jun.

Abstract

Purpose of review: Non-adherence to the medical regimen after kidney transplantation can contribute to poor clinical outcomes, and strategies to maximize adherence are sought by care providers and patients alike. We assessed recent evidence on prevalence, risk factors, and clinical outcomes associated with non-adherence to the medical regimen after kidney transplantation. We summarized recent clinical trials testing interventions to improve adherence and generated recommendations for future research and clinical practice.

Recent findings: A large evidence base documents rates of non-adherence to each of the multiple components of the regimen, including medication-taking, lifestyle activities, clinical care requirements, and substance use restrictions. Some risk factors for non-adherence are well known but the full range of risk factors remains unclear. Non-adherence to immunosuppressants and to other components of the regimen increases morbidity and mortality risks. Recent interventions, including education and counseling; electronic health strategies; and medication dose modifications, show promise for reducing immunosuppressant non-adherence. However, most of these interventions would be difficult to deploy in everyday clinical practice. Systematic dissemination of efficacious interventions into clinical practice has not been undertaken.

Summary: Rates and risk factors for non-adherence to the medical regimen have been examined and there is evidence that non-adherence may be ameliorated by a range of interventions. Although gaps in the evidence base remain, it would be timely to devote greater efforts to dissemination of findings. Thus, efforts are needed to assist transplant programs in using existing evidence to better identify patients who are non-adherent and to design and implement strategies to reduce or prevent non-adherence.

Keywords: Immunosuppressant non-adherence; Kidney transplantation; Medical non-adherence; Non-adherence interventions; Risk factors; Substance use.

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Conflict of interest statement

Conflict of Interest The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Strategies for incorporating evidence-based approaches into daily practice in order to maximize kidney recipients’ adherence to the posttransplant medical regimen (adapted from the work of Oberlin et al. [82•])
See this image and copyright information in PMC

References

    1. Dew MA, DeVito Dabbs A, Myaskovsky L, Shyu S, Shellmer DA, DiMartini AF, et al. Meta-analysis of medical regimen adherence outcomes in pediatric solid organ transplantation. Transplantation. 2009;88:736–46. - PMC - PubMed
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    1. Belaiche S, Décaudin B, Dharancy S, Noel C, Odou P, Hazzan M. Factors relevant to medication non-adherence in kidney transplant: a systematic review. Int J Clin Pharm. 2017;39:582–93. Because this report described a systematic review, the paper provides a thorough description of the range of rates of nonadherence reported in the literature, and the risk factors that have been examined to date. However, it is difficult to interpret the information on adherence rates because the duration of observation time differed in each study (i.e., patients observed for longer would have more opportunity to demonstrate nonadherence than those with short observation time). - PubMed

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