Individual and environmental correlates and predictors of early adherence and outcomes after liver transplantation.
BACKGROUND
Little is known about patients' contribution to health outcomes after liver transplantation. Yet, in other transplant recipients, nonadherent behavior is directly related to the leading causes of morbidity and mortality in liver transplant recipients.


OBJECTIVE
To examine patient and environmental factors in relation to all aspects of adherence to the posttransplantation regimen and health outcomes in the first 6 months after transplantation.


METHODS
A descriptive analysis of individual and environmental factors in relation to adherence and health outcomes at 6 months after liver transplantation.


METHODS
One hundred fifty-two adult liver transplant recipients at the University of Pittsburgh Medical Center.


METHODS
Adherence to medication taking, appointment keeping, lifestyle changes, mood, quality of life, and clinical markers of liver function.


RESULTS
Nonadherence was prevalent (47% with appointments, 73% with medication); relapse to drug/alcohol use occurred among a few recipients (5.6%), all with a history of substance abuse before transplantation. Patterns of coping, decision making, attitude, and social support were correlated with adherence, clinical markers, and psychological function (r = 0.22-0.45). Avoidant coping, affective dysregulation, and caregiver support emerged as robust predictors of negative clinical and mental health outcomes (beta = .224-.363).


CONCLUSIONS
This information about liver transplant recipients is important for researchers and clinicians. Researchers can develop guidelines by using stable but modifiable characteristics of patients to identify transplant candidates at risk of nonadherence. Such guidelines would enable clinicians to prepare patients better to manage the posttransplant regimen.
Stilley
Carol S
CS
University of Pittsburgh, Pittsburgh, Pennsylvania, USA. css100@pitt.edu
DiMartini
Andrea F
AF
de Vera
Michael E
ME
Flynn
William B
WB
King
Jennifer
J
Sereika
Susan
S
Tarter
Ralph E
RE
Dew
Mary Amanda
MA
Rathnamala
Geetha
G
D000223:Adaptation, Psychological; D000328:Adult; D000704:Analysis of Variance; D001071:Appointments and Schedules; D003657:Decision Making; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D016031:Liver Transplantation / Q000523:psychology* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D018579:Patient Selection; D010414:Pennsylvania; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D012648:Self Care / Q000379:methods / Q000523:psychology; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
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