Adherence to the medical regimen during the first two years after lung transplantation.
BACKGROUND
Despite the importance of adherence to the medical regimen for maximizing health after lung transplantation, no prospective studies report on rates or risk factors for nonadherence in this patient population. Whether adherence levels differ in lung versus other types of transplant recipients is unknown.


METHODS
A total of 178 lung recipients and a comparison group of 126 heart recipients were enrolled. Adherence in nine areas was assessed in separate patient and family caregiver interviews 2, 7, 12, 18, and 24 months posttransplant. Potential risk factors for nonadherence were obtained at the initial assessment.


RESULTS
Cumulative incidence rates of persistent nonadherence (i.e., nonadherence at > or =2 consecutive assessments) were significantly lower (P<0.05) in lung recipients than heart recipients for taking immunosuppressants (13% nonadherent vs. 21%, respectively), diet (34% vs. 56%), and smoking (1% vs. 8%). Lung recipients had significantly higher persistent nonadherence to completing blood work (28% vs. 17%) and monitoring blood pressure (70% vs. 59%). They had a high rate of spirometry nonadherence (62%; not measured in heart recipients). The groups did not differ in nonadherence to attending clinic appointments (27%), exercise (44%), or alcohol limitations (7%). In both groups, poor caregiver support and having only public insurance (e.g., Medicaid) increased nonadherence risk in all areas.


CONCLUSIONS
Lung recipients were neither uniformly better nor worse than heart recipients in adhering to their regimen. Lung recipients have particular difficulty with some home monitoring activities. Strategies to maximize adherence in both groups should build on caregiver support and on strengthening financial resources for patient healthcare requirements.
Dew
Mary Amanda
MA
1 Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA. dewma@upmc.edu
Dimartini
Andrea F
AF
De Vito Dabbs
Annette
A
Zomak
Rachelle
R
De Geest
Sabina
S
Dobbels
Fabienne
F
Myaskovsky
Larissa
L
Switzer
Galen E
GE
Unruh
Mark
M
Steel
Jennifer L
JL
Kormos
Robert L
RL
McCurry
Kenneth R
KR
D000328:Adult; D004644:Emotions; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000523:psychology; D006801:Humans; D007182:Income; D008137:Longitudinal Studies; D016040:Lung Transplantation / Q000523:psychology*; D008297:Male; D010349:Patient Compliance; D012944:Social Support; D016312:Treatment Refusal / Q000706:statistics & numerical data