Non-Adherence and Graft Failure in Adult Liver Transplant Recipients
Non-Adherence and Graft Failure in Adult Liver Transplant Recipients
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DOI：
10.1007/s10620-012-2412-0
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发表时间：
2013-03-01
影响因子：
3.1
通讯作者：
Volk, Michael L.
中科院分区：
文献类型：
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作者：
Lieber, Sarah R.;Volk, Michael L.
肝移植术后不依从药物治疗受到不同测量方法的混淆。(1)比较测量不依从性的三种不同方法的性能：（a）生化（标准差[SD]他克莫司水平），（B）临床医生报告，（c）自我报告。(2)确定移植后不依从的移植前预测因素。(3)为了评估SD他克莫司是否是移植物结局的准确预测因子，在这项回顾性队列研究中，对2003-2009年接受肝移植的成人患者（样本A，n = 444）的图表进行了回顾，以确定移植前非依从性预测因子和临床医生报告的非依从性。在移植后6至18个月之间测量SD他克莫司水平。样本A的一个子集（n = 122）完成了一项关于不依从性的调查。采用线性回归和Logistic回归对三种方法进行比较。多变量分析用于研究移植前非依从性的预测因素。在样本B中（移植受者1995-2003，n = 544），考克斯回归用于确定SD免疫抑制剂水平和移植失败之间的关系。临床医生报告的非依从性与自我报告和SD他克莫司相关。在多变量分析中，登记时的失业和移植前不依从的图表证据是他克莫司更高SD的显著预测因素。药物滥用史和移植前图表证据的不遵守也是显着的独立预测因素移植后图表证据的不遵守。移植后即刻的药物变异性与移植失败独立相关（标准差每增加一个单位，风险比为1.005，p = 0.04）。肝移植受者的不依从性是一个与移植失败风险增加相关的常见问题。SD他克莫司可用于测量非依从性行为，并可能针对患者进行行为干预。
Non-adherence to medical therapy after liver transplantation is confounded by different methods of measurement.(1) To compare the performance of three different methods of measuring non-adherence: (a) biochemical (standard deviation [SD] tacrolimus levels), (b) clinician report, (c) self-report. (2) To identify pre-transplant predictors of post-transplant non-adherence. (3) To evaluate whether SD tacrolimus is an accurate predictor of graft outcomes.In this retrospective cohort study, charts of adult recipients of a liver transplant 2003-2009 (sample A, n = 444) were reviewed to determine pre-transplant predictors of non-adherence and clinician report of non-adherence. SD tacrolimus levels were measured between 6 and 18 months post-transplant. A subset of sample A (n = 122) completed a survey on non-adherence. The three methods were compared using linear and logistic regression. Multivariable analysis was used to investigate pre-transplant predictors of non-adherence. In sample B (transplant recipients 1995-2003, n = 544) Cox regression was used to determine the relationship between SD immunosuppressant level and graft failure.Non-adherence was found in 22-62 % of subjects, with the highest rates indicated by self-report. Clinician report of non-adherence was associated with both self-report and SD tacrolimus. On multivariable analysis, unemployment at time of listing and chart evidence of pre-transplant non-adherence were significant predictors of higher SD of tacrolimus. History of substance abuse and pre-transplant chart evidence of non-adherence were also significant independent predictors of post-transplant chart evidence of non-adherence. Drug variability in the immediate post-transplant setting was independently associated with graft failure over time (hazard ratio 1.005 per unit increase in standard deviation, p = 0.04).Non-adherence among liver transplant recipients is a common problem associated with increased risk of graft failure. SD tacrolimus can be used to measure non-adherent behavior and perhaps target patients for behavioral interventions.