title: Self-reported non-adherence to immune-suppressant therapy in liver transplant recipients: demographic, interpersonal, and intrapersonal factors.
abstract: Adherence to immune suppressants and follow-up care regimen is important in achieving optimal long-term outcomes after organ transplantation. To identify patients most at risk for non-adherence, this cross-sectional, descriptive study explores the prevalence and correlates of non-adherence to immune-suppressant therapy among liver recipients. Anonymous questionnaires mailed consisted of the domains: (i) adherence barriers to immune suppressants, (ii) immune suppressants knowledge, (iii) demographics, (iv) social support, (v) medical co-morbidities, and (vi) healthcare locus of control and other beliefs. Overall response was 49% (281/572). Data analyzed for those transplanted within 10 yr of study reveal 50% (119/237) recipients or 9.2/100 person years reporting non-adherence. Non-adherence was reported highest in the 2-5 yr post-transplant phase (69/123, 56%). The highest immune-suppressant non-adherence rates were in recipients who are: divorced (26/34, 76%, p=0.0093), have a history of substance or alcohol use (42/69, 61%, p=0.0354), have mental health needs (50/84, 60%, p=0.0336), those who missed clinic appointments (25/30, 83%, p<0.0001), and did not maintain medication logs (71/122, 58%, p=0.0168). Respondents who were non-adherent with physician appointments were more than four and a half times as likely (OR 4.7, 95% CI 1.5-14.7, p=0.008) to be non-adherent with immune suppressants. In conclusion, half of our respondents report non-adherence to immune suppressants. Factors identified may assist clinicians to gauge patients' non-adherence risk and target resources.
authors.affiliation: Department of Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, University Hospital, Newark, NJ 07101, USA. lambasa@umdnj.edu
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Lamba
authors.forename: Roxanne
authors.initials: R
authors.lastname: Nagurka
authors.forename: Kunj K
authors.initials: KK
authors.lastname: Desai
authors.forename: Shaun J
authors.initials: SJ
authors.lastname: Chun
authors.forename: Bart
authors.initials: B
authors.lastname: Holland
authors.forename: Baburao
authors.initials: B
authors.lastname: Koneru
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007389:Internal-External Control; D016031:Liver Transplantation; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012944:Social Support; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents