Prednisolone noncompliance and outcome in liver transplant recipients

Abstract

Recently, we reported on the prevalence of prednisolone noncompliance in liver transplant recipients as measured by electronic monitoring [1]. In the group of 108 adult patients, a median of 4 years after transplantation, the median taking compliance was 100% (range: 60–105), median dosing compliance was 99% (range: 58–100), and median timing compliance was 94% (range: 42–100). A drug holiday of ‡48 h was found in 39% of the patients, of ‡72 h in 16% of the patients. After 2 years of followup, we now report on the possible influence of the measured noncompliance on clinical outcome. The following parameters of outcome were studied: liver tests as determined at baseline, and 1 and 2 years later; biopsy proven episodes of acute rejection for which treatment was needed; change in dosages of immunosuppression; hospital re-admissions, and patient and graft survival. Only one patient experienced an episode of rejection; 19% of patients achieved a substantial decrease of immunosuppression after 2 years; 19% of patients were hospitalized for several reasons; one patient died and another one received a second transplant. Except for a somewhat higher alkaline phosphatase (APh) in patients who showed the lowest level of compliance, we found no relations between the compliance parameters and outcome. Using rank correlation, at baseline a weak negative correlation was found between APh and taking compliance (P 1⁄4 0.024, r 1⁄4 )0.216), and between APh and dosing compliance (P 1⁄4 0.014, r 1⁄4 )0.236). A positive correlation was found at baseline between APh and drug holidays of ‡48 h (P 1⁄4 0.033, r 1⁄4 0.206). At 2 years of follow-up, APh was negatively correlated with dosing compliance (P 1⁄4 0.049, r 1⁄4 )0.192). See Fig. 1 for illustration. From the present study, it may be concluded that the level of prednisolone noncompliance of our liver