Journal article
Patient-reported immuno suppression nonadherence 6 to 24 months after liver transplant: association with pretransplant psychosocial factors and perceptions of health status change
Progress in transplantation (Aliso Viejo, Calif.), Vol.23(4), pp.319-328
12/01/2013
DOI: 10.7182/pit2013501
PMCID: PMC4127806
PMID: 24311395
Abstract
Context-Knowing the prevalence and risk factors of immunosuppression nonadherence after liver transplant may help guide intervention development.
Objective-To examine whether sociodemographic and psychosocial variables before liver transplant are predictive of nonadherence after liver transplant.
Design-Structured telephone interviews were used to collect self-report immunosuppression adherence and health status information. Medical record reviews were then completed to retrospectively examine the relationship between immunosuppression adherence and pretransplant variables, including sociodemographic and medical characteristics and the presence or absence of 6 hypothesized psychosocial risk factors.
Setting and Participants-A nonprobability sample of 236 adults 6 to 24 months after liver transplant at 2 centers completed structured telephone interviews.
Main Outcome Measure-Immunosuppressant medication nonadherence, categorized as missed-dose and altered-dose "adherent" or "nonadherent" during the past 6 months; immunosuppression medication holidays.
Results-Eighty-two patients (35%) were missed-dose nonadherent and 34 patients (14%) were altered-dose nonadherent. Seventy-one patients (30%) reported 1 or more 24-hour immunosuppression holidays in the past 6 months. Missed-dose nonadherence was predicted by male sex (odds ratio, 2.46; P=.01), longer time since liver transplant (odds ratio, 1.08; P=.01), pretransplant mood disorder (odds ratio, 2.52; P=.004), and pretransplant social support instability (odds ratio, 2.25; P=.03). Altered-dose nonadherence was predicted by pretransplant mood disorder (odds ratio, 2.15; P=.04) and pretransplant social support instability (odds ratio, 1.89; P=.03).
Conclusion-Rates of immunosuppressant nonadherence and drug holidays in the first 2 years after liver transplant are unacceptably high. Pretransplant mood disorder and social support instability increase the risk of nonadherence, and interventions should target these modifiable risk factors. (C) 2013 NATCO, The Organization for Transplant Professionals
Details
- Title: Subtitle
- Patient-reported immuno suppression nonadherence 6 to 24 months after liver transplant: association with pretransplant psychosocial factors and perceptions of health status change
- Creators
- James R. Rodrigue - Beth Israel Deaconess Medical CenterDavid R. Nelson - Beth Israel Deaconess Medical Center and the Harvard Medical School, Boston, Massachusetts (JRR, MPC), University of Florida, Gainesville (DRN), Washington University School of Medicine, St Louis, Missouri (DWH), University of Iowa, Iowa City (AIR)Douglas W. Hanto - Beth Israel Deaconess Medical Center and the Harvard Medical School, Boston, Massachusetts (JRR, MPC), University of Florida, Gainesville (DRN), Washington University School of Medicine, St Louis, Missouri (DWH), University of Iowa, Iowa City (AIR)Alan I. Reed - Beth Israel Deaconess Medical Center and the Harvard Medical School, Boston, Massachusetts (JRR, MPC), University of Florida, Gainesville (DRN), Washington University School of Medicine, St Louis, Missouri (DWH), University of Iowa, Iowa City (AIR)Michael P. Curry - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Progress in transplantation (Aliso Viejo, Calif.), Vol.23(4), pp.319-328
- DOI
- 10.7182/pit2013501
- PMID
- 24311395
- PMCID
- PMC4127806
- NLM abbreviation
- Prog Transplant
- ISSN
- 1526-9248
- eISSN
- 2164-6708
- Publisher
- Innovision Communications
- Number of pages
- 10
- Grant note
- Center for Transplant Outcomes and Quality Improvement D71HS22061 / HRSA; United States Department of Health & Human Services; United States Health Resources & Service Administration (HRSA) UL1RR029890 / NATIONAL CENTER FOR RESEARCH RESOURCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Research Resources (NCRR) Julie Henry Research Fund UL1 RR029890 / NIH/NCRR Clinical and Translational Science Award to the University of Florida R01DK085185 / NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) Transplant Institute, Beth Israel Deaconess Medical Center, Boston R24HS022061 / AGENCY FOR HEALTHCARE RESEARCH AND QUALITY; United States Department of Health & Human Services; Agency for Healthcare Research & Quality DK079665; DK085185 / NIH/NIDDK; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK)
- Language
- English
- Date published
- 12/01/2013
- Academic Unit
- Accounting; Surgery
- Record Identifier
- 9984322928102771
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