Adherence to immunosuppression in adult lung transplant recipients: Prevalence and risk factors
Adherence to immunosuppression in adult lung transplant recipients: Prevalence and risk factors
复制标题
DOI：
10.1016/j.healun.2011.05.007
复制
发表时间：
2011-11-01
影响因子：
8.9
通讯作者：
van der Bij, Wim
中科院分区：
文献类型：
--
作者：
Bosma, Otto H.;Vermeulen, Karin M.;van der Bij, Wim
背景：坚持药物治疗对于肾、心、肝移植后的生存是有利的。对于肺移植受者的药物依从性知之甚少。为了确定依从性的患病率和确定不依从性（NA）的危险因素，我们评估了移植后至少1年的成人肺移植受者对他克莫司的依从性。方法：采用用药事件监测系统（MEMS）前瞻性监测他克莫司的摄入量。如果时间依从性评分达到>= 80%，则受者符合依从性。采用Karnofsky绩效指数、自我护理机构ASA量表、状态-特质焦虑量表、Zung抑郁自评量表和长期用药行为自我效能量表收集NA患者的特征和可能的危险因素。结果：91名受者使用MEMS的时间中位数为95天（范围50至124天），并被纳入。他们的中位时间依从性评分为98.1%（范围为31.2%至100%）。92.3%的接受者的时间依从性评分为>= 80%。多元逻辑回归结果显示，时间依从性得分较低与年龄较轻及自我照顾能力较低有关。结论：肺移植受者对免疫抑制治疗的依从性非常高。只有7.7%的接受者没有依从性。年轻的接受者和自我护理能力较低的接受者似乎有NA的风险。需要对临床资料进行随访，以确定NA是否与较差的预后相关，特别是闭塞性细支气管炎综合征。心肺移植杂志；2011；[C] 2011国际心肺移植学会。版权所有。
BACKGROUND: Adherence to medication is a favourable with regard to survival after kidney, heart and liver transplantation. Little is known about adherence to medication in lung transplant recipients. To determine the prevalence of adherence and identify risk factors of non-adherence (NA) we evaluated adherence to tacrolimus in adult lung transplant recipients who were at least 1 year after transplantation.METHODS: Tacrolimus intake was prospectively monitored using the Medication Event Monitoring System (MEMS). Recipients qualified as adherent if a timing-adherence score of >= 80% was reached. Patients' characteristics and possible risk factors for NA were collected using the Karnofsky Performance Index, Self-Care Agency ASA Scale, State-Trait Anxiety Inventory, Zung Self-Rating Depression Scale, and the Long-Term Medication Behavior Self-Efficacy Scale.RESULTS: Ninety-one recipients used MEMS for a median of 95 days (range 50 to 124 days) and were included. They showed a median timing-adherence score of 98.1% (range 31.2% to 100%). A timing-adherence score of >= 80% was seen in 92.3% of the recipients. Multiple logistic regression showed an association of lower timing-adherence scores with younger age an I lower ability of self-care.CONCLUSIONS: Adherence to immunosuppressive therapy was very high in lung transplant recipients. Only 7.7% of the recipients were non-adherent. Younger recipients and recipients with lower ability of self-care appeared to be at risk for NA. Follow-up of clinical data is needed to determine whether NA is associated with poorer outcome, specifically bronchiolitis obliterans syndrome. J Heart Lung Transplant 2011;30:1275-80 (C) 2011 International Society for Heart and Lung Transplantation. All rights reserved.