Demographic Factors, Medication Adherence, and Post-transplant Health Outcomes: A Longitudinal Multilevel Modeling Approach.
Demographic Factors, Medication Adherence, and Post-transplant Health Outcomes: A Longitudinal Multilevel Modeling Approach.
复制标题
人口因素、药物依从性和移植后健康结果：纵向多级建模方法。
DOI：
10.1007/s10880-023-09970-4
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发表时间：
2024
影响因子：
2.2
通讯作者：
Desai,DevM
中科院分区：
文献类型：
--
作者：
Killian,MichaelO;Little,CallieW;Howry,SavarraK;Watkivs,Madison;Triplett,KelliN;Desai,DevM
很少有关于儿科实体器官移植的研究探讨了随着时间的推移不坚持免疫抑制药物及其与人口因素和移植后结果（包括晚期急性排斥反应和住院治疗）的关系。我们检查了儿科肾、肝和心脏移植受者的患者药物水平变异指数 (MLVI) 依从性数据的纵向变化。来自器官共享联合网络的患者和管理数据与 332 名患者的电子健康记录和 MLVI 值相关联。多级中介模型表明，移植后 10 多年里，患者之间的 MLVI 值纵向变化比患者内部的变化更大。 MLVI 值显着预测晚期急性排斥反应和住院治疗。 MLVI 部分调节患者因素和移植后结果与患者年龄的关系，表明青少年可能从干预措施中受益最多。结果证明了纵向评估患者依从性和差异的重要性。促进药物依从性的努力应适应高危患者，以增加依从性的可能性。
Few studies in pediatric solid organ transplantation have examined non-adherence to immunosuppressive medication over time and its associations with demographic factors and post-transplant outcomes including late acute rejection and hospitalizations. We examined longitudinal variation in patient Medication Level Variability Index (MLVI) adherence data from pediatric kidney, liver, and heart transplant recipients. Patient and administrative data from the United Network for Organ Sharing were linked with electronic health records and MLVI values for 332 patients. Multilevel mediation modeling indicated comparatively more variation in MLVI values between patients than within patients, longitudinally, over 10 years post transplant. MLVI values significantly predicted late acute rejection and hospitalization. MLVI partially mediated patient factors and post-transplant outcomes for patient age indicating adolescents may benefit most from intervention efforts. Results demonstrate the importance of longitudinal assessment of adherence and differences among patients. Efforts to promote medication adherence should be adapted to high-risk patients to increase likelihood of adherence.