Patient-reported immunosuppression nonadherence 6 to 24 months after liver transplant: association with pretransplant psychosocial factors and perceptions of health status change.
Patient-reported immunosuppression nonadherence 6 to 24 months after liver transplant: association with pretransplant psychosocial factors and perceptions of health status change.
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DOI：
10.7182/pit2013501
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发表时间：
2013-12
期刊：
影响因子：
--
通讯作者：
Curry MP
中科院分区：
文献类型：
--
作者：
Rodrigue JR;Nelson DR;Hanto DW;Reed AI;Curry MP
了解肝移植后免疫抑制不依从的患病率和危险因素可能有助于指导干预措施的制定。检查肝移植前的社会人口统计学和社会心理变量是否可以预测肝移植后的不依从性。采用结构化电话访谈来收集自我报告的免疫抑制依从性和健康状况信息。然后完成病历审查，回顾性检查免疫抑制依从性与移植前变量之间的关系，包括社会人口统计学和医学特征以及是否存在 6 种假设的社会心理危险因素。 2 个中心肝移植后 6 至 24 个月的 236 名成年人的非概率样本完成了结构化电话访谈。免疫抑制剂药物不依从性，分为过去 6 个月内漏服剂量和改变剂量“依从性”或“不依从性”；免疫抑制药物假期。 82 名患者 (35%) 为漏服剂量不依从性，34 名患者 (14%) 为改变剂量不依从性。 71 名患者 (30%) 报告在过去 6 个月内有 1 次或多次 24 小时免疫抑制假期。男性（比值比，2.46；P = .01）、肝移植后较长时间（比值比，1.08；P = .01）、移植前情绪障碍（比值比，2.52；P = .004）和移植前社会支持不稳定（比值比，2.25；P = .03）预测漏服不依从性。移植前情绪障碍（比值比，2.15；P = .04）和移植前社会支持不稳定（比值比，1.89；P = .03）预测改变剂量不依从性。肝移植后头两年内不遵守免疫抑制剂和停药的比例高得令人无法接受。移植前情绪障碍和社会支持不稳定会增加不依从的风险，干预措施应针对这些可改变的风险因素。
Knowing the prevalence and risk factors of immunosuppression nonadherence after liver transplant may help guide intervention development. To examine whether sociodemographic and psychosocial variables before liver transplant are predictive of nonadherence after liver transplant. 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. A nonprobability sample of 236 adults 6 to 24 months after liver transplant at 2 centers completed structured telephone interviews. Immunosuppressant medication nonadherence, categorized as missed-dose and altered-dose “adherent” or “nonadherent” during the past 6 months; immunosuppression medication holidays. 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). 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.
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影响因子：
19.6
作者：
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通讯作者：
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影响因子：
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影响因子：
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