title: Immunosuppressive therapy after solid-organ transplantation: does the INTERMED identify patients at risk of poor adherence?
abstract: BACKGROUND
  Lack of adherence to medication is a trigger of graft rejection in solid-organ transplant (SOT) recipients.
  
  
  OBJECTIVE
  This exploratory study aimed to assess whether a biopsychosocial evaluation using the INTERMED instrument before transplantation could identify SOT recipients at risk of suboptimal post-transplantation adherence to immunosuppressant drugs. We hypothesized that complex patients (INTERMED>20) might have lower medication adherence than noncomplex patients (INTERMED≤20).
  
  
  METHODS
  Each patient eligible for transplantation at the University Hospital of Lausanne, Switzerland, has to undergo a pre-transplantation psychiatric evaluation. In this context the patient was asked to participate in our study. The INTERMED was completed pre-transplantation, and adherence to immunosuppressive medication was monitored post-transplantation by electronic monitors for 12 months. The main outcome measure was the implementation and persistence to two calcineurin inhibitors, cyclosporine and tacrolimus, according to the dichotomized INTERMED score (>20 or ≤20).
  
  
  RESULTS
  Among the 50 SOT recipients who completed the INTERMED, 32 entered the study. The complex (N=11) and noncomplex patients (N=21) were similar in terms of age, sex and transplanted organ. Implementation was 94.2% in noncomplex patients versus 87.8% in complex patients (non-significant p-value). Five patients were lost to follow-up: one was non-persistent, and four refused electronic monitoring. Of the four patients who refused monitoring, two were complex and withdrew early, and two were noncomplex and withdrew later in the study.
  
  
  CONCLUSIONS
  Patients identified as complex pre-transplant by the INTERMED tended to deviate from their immunosuppressant regimen, but the findings were not statistically significant. Larger studies are needed to evaluate this association further, as well as the appropriateness of using a nonspecific biopsychosocial instrument such as INTERMED in highly morbid patients who have complex social and psychological characteristics.
authors.affiliation: Psychiatric Liaison Service, University Hospital of Lausanne (CHUV). Lausanne ( Switzerland ). Laurent.Michaud@chuv.ch.
authors.forename: Laurent
authors.initials: L
authors.lastname: Michaud
authors.affiliation: Psychiatric Liaison Service, University Hospital of Lausanne (CHUV). Lausanne ( Switzerland ). Gundula.Ludwig@chuv.ch.
authors.forename: Gundula
authors.initials: G
authors.lastname: Ludwig
authors.affiliation: General Psychiatry Service, University Hospital of Lausanne (CHUV). Lausanne ( Switzerland ). Sylvie.Berney@chuv.ch.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Berney
authors.affiliation: University Hospital of Lausanne (CHUV). Lausanne ( Switzerland ). Stephanie.Rodrigues@chuv.ch.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Rodrigues
authors.affiliation: Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne . Lausanne ( Switzerland ). Anne.Niquille@hospvd.ch.
authors.forename: Anne
authors.initials: A
authors.lastname: Niquille
authors.affiliation: Professor, La Source School of Nursing Sciences, University of Applied Sciences Western Switzerland . Lausanne ( Switzerland ). v.santschi@ecolelasource.ch.
authors.forename: Valérie
authors.initials: V
authors.lastname: Santschi
authors.affiliation: Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne . Lausanne ( Switzerland ). Anne-Sophie.Favre@hospvd.ch.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Favre
authors.affiliation: Westrock Healthcare. Visé ( Belgium ). annecatherine.lange@westrock.com.
authors.forename: Anne-Catherine
authors.initials: AC
authors.lastname: Lange
authors.affiliation: Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne . Lausanne ( Switzerland ). Annemieke.Michels@hospvd.ch.
authors.forename: Annemieke A
authors.initials: AA
authors.lastname: Michels
authors.affiliation: University of Liège , Belgium and Chief Science Officer, Westrock Healthcare. Visé ( Belgium ). bernard.vrijens@westrock.com.
authors.forename: Bernard
authors.initials: B
authors.lastname: Vrijens
authors.affiliation: School of pharmaceutical sciences, University of Geneva, University of Lausanne , Switzerland and Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne. Lausanne ( Switzerland ). Olivier.Bugnon@hospvd.ch.
authors.forename: Olivier
authors.initials: O
authors.lastname: Bugnon
authors.affiliation: Transplantation Centre, University Hospital of Lausanne (CHUV) . Lausanne ( Switzerland ). Nathalie.Pilon@chuv.ch.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Pilon
authors.affiliation: Transplantation Centre, University Hospital of Lausanne (CHUV) . Lausanne ( Switzerland ). Manuel.Pascual@chuv.ch.
authors.forename: Manuel
authors.initials: M
authors.lastname: Pascual
authors.affiliation: Transplantation Centre, University Hospital of Lausanne (CHUV) . Lausanne ( Switzerland ). Jean-Pierre.Venetz@chuv.ch.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Venetz
authors.affiliation: Psychiatric Liaison Service, University Hospital of Lausanne (CHUV). Lausanne ( Switzerland ). Frederic.Stiefel@chuv.ch.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Stiefel
authors.affiliation: Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne , Switzerland and Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne . Lausanne ( Switzerland ). Marie-Paule.Schneider@hospvd.ch.
authors.forename: Marie-Paule
authors.initials: MP
authors.lastname: Schneider
keywords: Adaptation; Medication Adherence; Organ Transplantation; Patient Care Team; Personality Assessment; Psychological; Switzerland