Abstract
Non-adherence to therapy is associated with impaired outcome in solid organ allograft recipients. Outcome data are limited after lung transplantation. In a single-center cohort study, adherence was assessed in 427 patients undergoing lung transplantation from 2010 to 2013. Objective criteria of adherence were judged by health care workers on every visit on a five item Likert scale including trough level monitoring, home spirometry and contact with an overall rating of adherence between 0 and 100%. Cut-off values for good vs. suboptimal adherence were defined retrospectively. Primary outcome was allograft survival, secondary outcomes were patient survival, prevalence of chronic lung allograft dysfunction, hospitalizations, renal function and quality of life. Follow-up ended on 31st December 2018. Median adherence was 86% on 6,623 visits, this cut-off was used as a discriminator between good and suboptimal adherers. Patients with good adherence within the first three years showed better 5-year allograft (74% vs. 60%, p = 0.003) and patient survival (79% vs. 64%, p<0.001) and lower prevalence of chronic allograft dysfunction (33% vs. 45%, p = 0.011) after 5 years compared to patients with suboptimal adherence. A multidimensional adherence score proved to be a simple tool to assess adherence in clinical practice. Suboptimal adherence was associated with impaired outcome in lung transplant patients.
Highlights
Lung transplantation (LTx) is an important therapeutic option in end stage pulmonary diseases, such as pulmonary fibrosis, emphysema, cystic fibrosis (CF), or pulmonary hypertension
Long-term allograft survival is limited by the development of chronic lung allograft dysfunction (CLAD), malignancy, infections, and comorbidities[1,2]
We have previously published the association of non-adherence with home spirometry and chronic lung allograft dysfunction (CLAD) in LTx recipients[12]
Summary
Lung transplantation (LTx) is an important therapeutic option in end stage pulmonary diseases, such as pulmonary fibrosis, emphysema, cystic fibrosis (CF), or pulmonary hypertension. Non-adherence to therapy has been associated with impaired outcome in solid organ transplantation[3,4,5]. Adherence can be estimated by health care workers, with use of patients’ self-reports[8] and other instruments. Non-adherence with immunosuppressive medication was associated with impaired survival of lung transplant patients in a large US registry analysis[11]. We have previously published the association of non-adherence with home spirometry and chronic lung allograft dysfunction (CLAD) in LTx recipients[12]. Other factors, such as health awareness, lifestyle or regular contact to the transplant center, might influence outcome and may be useful in evaluating patient adherence. We introduce our adherence score and analyze its potential predictive power on patient outcome
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