Immunosuppressant Therapy Adherence Research Articles

Interventions to improve immunosuppressant therapy adherence after organ transplantation

Interventions to improve immunosuppressant therapy adherence after organ transplantation

Mindfulness-based cognitive therapy for adherence of immunosuppressive treatment in liver transplant recipients: A randomized controlled trial

ObjectiveThe aim of this study was to analyze the effects of mindfulness-based cognitive therapy on the adherence of liver transplant recipients to immunosuppressive therapy with a randomized controlled design. MethodThis randomized controlled trial was performed with 120 liver transplant recipients hospitalized at the liver transplant department of a research and practice hospital (n = 120). While we administered no intervention to the patients in the control group (n = 60), we provided Mindfulness-Based Cognitive Therapy to those in the experimental group (n = 60). We used the Mindful Attention Awareness Scale and the Immunosuppressant Therapy Adherence Scale to collect data. We utilized descriptive statistics, paired-samples t-tests, independent-samples t-tests, one-way analysis of variance, and chi-squared tests to analyze the data. ResultsAfter the intervention, the immunosuppressive therapy adherence levels of the experimental group increased significantly (p < 0.01). On the other hand, the control group had significantly higher adherence to immunosuppressive therapy and significantly higher levels of mindfulness in the pretest phase than it did in the posttest phase (p < 0.01). ConclusionsComplete adherence to immunosuppressive therapy is imperative for the prevention of graft rejection in liver transplant recipients. In our study, the experimental group equipped with enhanced mindfulness had higher adherence to immunosuppressive therapy. Therefore, the use of Mindfulness-Based Cognitive Therapy in the promotion of adherence to immunosuppressive therapy is recommended.

The analysis of the adherence of liver transplant recipients to immunosuppressant treatment, their self-control, and self-management in the post-transplantation period

In our study, it was aimed to investigate the adherence of liver transplant recipients to immunosuppressant therapy, their self-control, and their self-management in the post-transplantation period. The sample of this descriptive and cross-sectional study was composed of liver transplant recipients. The personal information form, Immunosuppressant Therapy Adherence Scale, and the Liver Self-Control and Self-Management Scale were used to collect data, and descriptive statistical methods, independent samples t-test and one-way analysis of variance analysis was used to analyze the collected data. In light of the data collected in this study, it was identified that, of all recipients, 73.6% were 45–64 years old, 72.5% were male, 25.2% were workers, and 44.6% had equivalent income and expenses. It was observed that the recipients did not fully adhere to the immunosuppressant therapy regimen, and their self-control and self-management levels were below the medium level. The social support system of liver transplant recipients is very important. Recipients with a good social support system can receive caregiver support from their relatives, thereby supporting their self-control and self-management. Both liver transplant patients and the people providing care to them should be simultaneously provided with training programs and given information, and both groups should be supported in treatment and care processes.

Assessment of the Effectiveness of Patient Education and Interviews in Improving Medication Adherence of Renal Transplant Recipients.

Background Non-compliance with immunosuppressive drugs has been reported as the most significant cause of graft loss.Since non-compliance with immunosuppressive drugs is preventable, certain approaches based on the risk factors and causes of non-compliance can help eliminate this problem. Aims The purpose of this study is to assess the effectiveness of patient education and interviews in improving medication adherence of renal-transplant recipients. Materials and methods This study was designed as a randomized controlled trial. Using the G*Power program, the sample size was calculated as 60 subjects, with 30 in both the intervention groupand control group.Data collection tools included a patient information form,a pretest-posttest, a drug monitoring form for kidney transplant patients,the Immunosuppressive Therapy Adherence Scale, measurement of tacrolimus blood levels,and a training booklet. Results The mean knowledge score in the intervention group was 12.17±3.39 at baseline, and it increased to 20.73±1.57 after the intervention. The mean scores on the Immunosuppressant Therapy Adherence Scale were 11.67±0.55 and 10.70±0.99 in the intervention group and control group, respectively. There was a statistically significant difference between the pre-test and post-test means on the Immunosuppressant Therapy Adherence Scale in the intervention group. The mean Immunosuppressant Therapy Adherence Scalescore was higher in the intervention group. In the measurement of tacrolimus blood levels, medication adherence was found the be higher in the intervention group. The difference between the groups was statistically significant. There was a positive correlation between the tacrolimus blood levels and the Immunosuppressant Therapy Adherence Scalescores in both groups. Conclusions To conclude, our results have demonstrated that patient education and interviews improve immunosuppressant medication adherence in renal transplant recipients. Using direct or indirect methodsproved similar outcomes, suggesting that both evaluation methods are safe.

The analysis of immunosuppressant therapy adherence, depression, anxiety, and stress in kidney transplant recipients in the post-transplantation period

AimOur study aimed to analyze the immunosuppressant therapy adherence, anxiety, stress, and depression in kidney transplant recipients in the post-transplantation period. MethodThis study was conducted as descriptive and cross-sectional research with the participation of 260 recipients who underwent kidney transplantation and were already discharged from the hospital (n = 260). In the data collection process, we used the Personal Information Form, the Immunosuppressant Therapy Adherence Scale (ITAS), and the Depression Anxiety Stress Scale (DASS)-21. The One-Way Analysis of Variance (ANOVA), Chi-Squared test, post hoc and Pearson Correlation analysis methods were used in data analysis. FindingsIn our study all participant kidney transplant recipients, 45.4% were age 46–64 years and 81.5% were men. As the recipients' age levels increased, their immunosuppressant therapy adherence levels decreased (p < 0.05). Similarly, kidney recipients with at least 3 adverse events (infection, gastrointestinal problems, edema, blood disorders etc.) had a higher DASS-21 score and a lower ITAS score than those with low side effects. ITAS had a strong negative relationship with DASS-21 (p < 0.05). Recipients' depression, stress, and anxiety scores were, in general, above the medium level. ConclusionAdherence to the immunosuppressive drug regimen after kidney transplantation and depression, anxiety and stress are in a bidirectional relationship. At the same time, the side effects of immunosuppressive drugs can trigger the development of depression, anxiety and stress. After kidney transplant, recipients are at risk for the development of depression, anxiety, and stress. We recommend early detection of this condition and taking preventive and symptom-reducing interventions.

Investigation of adherence to immunosuppressive therapy and spiritual well-being in liver recipients

ObjectiveIn our study, we investigated the relationship between spiritual well-being and adherence to immunosuppressive therapy after liver transplantation. MethodWe conducted this descriptive and cross-sectional study with the participation of 131 liver transplant recipients after they had received their transplants. Data collection was carried out using a Personal Information Form, the Spiritual Well-Being Scale and the Immunosuppressant Therapy Adherence Scale. The IBM Statistical Package for the Social Sciences 25.0 was used for the statistical analyses. ResultsWhile 73.3% of the patients were at the ages of 45–64, 72.5% were male, and 39.7% had been using immunosuppressive medication for a period between 6 months and 1 year. The rate of corticosteroid use among the patients was 30.5%, and the rate of antimetabolite use was 21.4%. A positive and significant relationship was found between adherence to immunosuppressive treatment and spiritual well-being (B = 0.425, p = 0.017). ConclusionSpiritual well-being is an inexpensive, effective and easy strategy to increase adherence to immunosuppressive treatment. Awareness should be raised in physicians and nurses about the importance of spiritual well-being, and they should be encouraged to support spiritual well-being.

The effect of adherence to immunosuppressant therapy on gastrointestinal complications after liver transplantation

AimIn our study, we examined the relationship between gastrointestinal system problems and adherence to immunosuppressant therapy after liver transplantation. MethodWe performed this study as descriptive and cross-sectional research with the participation of liver transplant recipients. In the data collection, we used the Personal Information Form, the Gastrointestinal Symptom Rating Scale, and the Immunosuppressant Therapy Adherence Scale. In the data analysis, we utilized the IBM Statistical Package for Social Science 25.0. FindingsIn our study, it was discerned that, of all liver transplant recipients (n = 331), 45.9% were aged 45–64 years, 77.3% were male, and 93.4% were married. Besides, 36.9% of liver transplant recipients were utilizing immunosuppressive agents for 1 month – 89 days. Next, it was identified that liver transplant recipients mostly used tacrolimus (67.4%), mycophenolate mofetil (65.6%), and prednisolone (76.7%). It was found that tacrolimus, mycophenolate mofetil, biological agents, and other immunosuppressants were associated with the development of gastrointestinal system problems. ConclusionThe management of gastrointestinal system disorders is extremely importance to ensure that liver transplant recipients can adhere to immunosuppressant therapy. The awareness of liver transplant recipients about gastrointestinal system disorders and complications should be increased and their management should be assisted.

The Effect of Immunosuppressant Therapy Adherence on the Comfort of Liver Transplant Recipients.

Inadequate immunosuppressive therapy causes rejection, whereas an overdose may lead to infections or malignancy to affect a patient's life and comfort. This study used a descriptive correlational design to determine how compliance with immunosuppressive therapy affected the well-being of liver transplant patients. The study was conducted in the liver transplant unit of a university hospital with 103 patients who underwent liver transplant surgery. The target population included patients who received treatment in liver transplant clinics between July 2016 and August 2017. Mean age of the patients in the study was 44.66 ± 14.86 years and the time after transplant was 15.48 ± 16.90 months on the average. A significant difference was found between mean General Comfort Scale scores according to the variable of adherence status (t = 6.898, p < .05). Simple linear regression analysis showed a positive moderate, significant correlation between the adherence variable and mean General Comfort Scale scores (R = 0.543, p < .001). It was found that the patients who adhered to immunosuppressive therapy experienced higher levels of comfort. Therefore, arrangements to improve patient adherence to therapy, hence comfort, are recommended, as well as periodic evaluations of patient comfort levels.

Prevalence of Non-Adherence to Immunosuppressive Medications in Kidney Transplant Recipients: Barriers and Predictors.

BackgroundNon-adherence to immunosuppressant therapy (IST) is a major risk factor for graft rejection. Limited reports are available regarding the prevalence of non-adherence to IST in kidney transplant recipients (KTRs) as well as the predictors and barriers of non-adherence.Material/MethodsThe study included ambulatory KTRs, ≥18 years of age, with a functional kidney, from January 2017 to November 2018. The primary outcome was the prevalence of non-adherence, assessed with: 1) A telephone interview to complete the Arabic-translated and validated Immunosuppressant Therapy Adherence Instrument Scale (ITAS) and 2) IST serum blood levels within therapeutic levels. The secondary outcomes were the barriers to adherence using the validated Immunosuppressant Therapy Barriers of Adherence Scale (ITBS).ResultsWe enrolled 102 of 141 patients screened. The mean±SD for age, body mass index, and the baseline of the estimated glomerular filtration rate were 45.5±15.6 years, 29.1±6 kg/m2, and 72.7±21.9 ml/min/1.73 m2, respectively. The prevalence of non-adherence was 5.9%, 95% CI (2.19–12.36%) and 14.7%, 95% CI (8.47–23.09%) using the ITAS and the average blood serum drug levels, respectively. The concordance of the 2 methods demonstrated an agreement of 81.3%, kappa of 0.01, and 95% CI (−0.16 to 0.18). The median, interquartile range (IQR) for ITBS, and uncontrollable and controllable barriers for adherence were 21, (18–25), 15, (12–18), and 6, (5–8), respectively.ConclusionsThe current study demonstrated a low to moderate prevalence of non-adherence to IST in KTRs. The barriers for adherence with IST necessitate additional targeted interventions to manage and optimize therapeutic and clinical outcomes.

A Prospective Survey of Outpatient Medication Adherence in Adult Allogeneic Hematopoietic Stem Cell Transplantation Patients.

Limited data exist regarding the prevalence and outcome of medication nonadherence in the adult allogeneic hematopoietic stem cell transplantation (allo-HSCT) population. The objective of this cross-sectional survey study is to determine the prevalence of medication nonadherence to immunosuppressant and nonimmunosuppressant medications in adult recipients of allo-HSCT. An electronic survey using previously validated medication adherence scales was distributed between December 2014 and April 2015 to 200 adult patients with at least 3 months of follow-up after allo-HSCT. Immunosuppressant serum drug levels and prescription refill records were retrospectively collected to assess correlation with survey responses. In the entire cohort, 51% of subjects (n=102) reported nonadherence to nonimmunosuppressant medications (95% confidence interval [CI], 44.07% to 57.93%) on the Morisky Medication Adherence Scale. Of the 153 patients taking oral immunosuppressant medications at the time of the survey, 58 (37.9%) reported nonadherence to immunosuppressant therapy (95% CI, 30.22% to 45.6%), as measured by the Immunosuppressant Therapy Adherence Scale. Younger age and distress were associated with medication nonadherence. Nonadherence to immunosuppressant therapy was associated with mild chronic graft-vs-host disease (cGVHD), and a similar trend was observed for moderate cGVHD. Medication nonadherence was found to be highly prevalent for both immunosuppressant and nonimmunosuppressant medications in adult allo-HSCT recipient, and further study to identify interventions to improve adherence in these patients is warranted.

Association between Posttransplant Opioid Use and Immunosuppressant Therapy Adherence among Renal Transplant Recipients

Introduction: Little is known about the effect of posttransplant opioid use on adherence to immunosuppressant therapy (IST) among adult renal transplant recipients (RTRs). Objective: The aim of this study was to examine the relationship between opioid use and IST adherence among adult RTRs during the first year posttransplant. Methods: Longitudinal data were analyzed from a retrospective cohort study examining US veterans undergoing renal transplant from October 1, 2007, through March 31, 2015. Data were collected from the US Renal Data System, Centers for Medicare and Medicaid Services Data (Medicare Part D), and Veterans Affairs pharmacy records. Dose of opioid prescriptions was collected and divided based on annual morphine milligram equivalent within a year of transplant. Proportion of days covered of greater than or equal to 80% indicated adherence to tacrolimus. Unadjusted and multivariable-adjusted logistic regression analyses were performed. Results: A study population of 1,229 RTRs included 258 with no opioid use, while 971 opioid users were identified within the first year after transplantation. Compared to RTRs without opioid usage, RTRs with opioid usage had a lower probability of being adherent to tacrolimus in unadjusted logistic regression (odds ratio [OR] (95% confidence interval [CI]): 0.22 [0.07–0.72]) and adjusted logistic regression (OR [95% CI]: 0.11 [0.03–0.44]). These patterns generally remained consistent in unadjusted and adjusted main and sensitivity analyses. Conclusions: Findings indicate RTRs who use prescription opioids during the first year posttransplant, regardless of the dosage/amount, are less likely to be adherent to tacrolimus. Future studies are needed to better understand underlying causes of the association between opioid use and tacrolimus nonadherence.

232.1: Mobile directly observed therapy for immunosuppression adherence in adult kidney transplant recipients: A pilot randomized controlled trial.

Background: The leading predictor of rejection, de novo DSA, graft loss, and death among adult kidney transplant (KT) recipients is immunosuppressive medication nonadherence. An estimated one-third of kidney transplant recipients reportedly experience medication nonadherence. To understand if mobile technology with asynchronous, video directly observed therapy can be leveraged in adult KT recipients to improve medication adherence habits, we adapted a mobile smartphone application (mDOT) that has previously been shown to increase medication adherence among tuberculous patients. This protocol has been reviewed and approved by the applicable institutional review boards with respect to scientific content and compliance with applicable research and human subjects regulations. Methods: We are testing the feasibility of implementing mDOT for transplantation in a pilot randomized control trial (RCT). Key features of mDOT for transplantation include a HIPAA-compliant patient-facing smartphone app and transplant provider-facing web portal, symptom and side-effect tracking and reporting, dose-by dose medication tracking with video observation by transplant pharmacy capability, text message and push notifications for medication reminders, and two-way in-app secure messaging between patient and provider. Our ongoing pilot RCT (NCT03427008) is evaluating mDOT on rates of post-transplant immunosuppression medication adherence in adult KT recipients in preparation for a fully-powered multi-site clinical trial. Participants are randomized to the intervention (mDOT) or control arm (standard of care) using block randomization. Immunosuppression adherence is tracked over time through medical record abstraction of laboratory values in addition to the self-reported immunosuppressant therapy adherence instrument. Qualitative feedback on the feasibility and usability of mDOT for transplantation is collected from patients through a telephone interview and post-satisfaction survey at the end of their 12-weeks in the study (Figure). Results: We have enrolled 10 adult KT recipients as of October 2018. 50% of the patients identify as white and 50% as black. 70% of these patients are male and median age is 57.5 (IQR: 45.0, 61.0) (Table). Feedback from patients and video reviewers have allowed us to optimize the app to foster greater patient-provider communication and user-friendliness. Clinical outcomes and qualitative feedback will be available at the time of ISODP. Conclusions: Designed to facilitate immunosuppression adherence and engagement with transplant providers, mDOT may be a promising technology for adult KT recipients in the early post-transplant period. National Institute of Diabetes and Digestive and Kidney Diseases K01DK114388. National Institute of Diabetes and Digestive and Kidney Diseases K24DK101828. National Institute of Diabetes and Digestive and Kidney Diseases K01DK101677. Johns Hopkins University Discovery Award.

The Portuguese Version of the Immunosuppressant Therapy Adherence Scale (ITAS) among Liver Transplant Recipient Patients: Translation and Psychometric Properties

Introduction and aim. Transplant recipients are chronically ill patients who rely on medical treatment throughout life to achieve positive results. Despite that, medication nonadherence after liver transplantation is extremely common. The self-report, one of several methods for measuring adherence, is easy to apply and low cost. Thus, this study aims to translate and validate the Immunosuppressant Therapy Adherence Instrument (ITAS) in Brazilian Portuguese for liver transplant recipients.Material and methods. A total of 139 liver transplant recipients were selected from a general hospital, who were assessed by using the Portuguese version of ITAS. The scale was translated based on the model proposed by Wild, et al. and its psychometric properties were assessed.Results. The average Cronbach’s a coefficient was 0.830. ITAS and Basel Assessment of Adherence with Immunosuppressive Medications Scale (BAASIS) presented significant correlation, with a Spearman’s p coefficient = 0.300 (S = 309,580; p < 0.001). The area under the receiver operating characteristics (ROC) curve was 0.638 (95% CI: 0.557 – 0.715). Factor analysis results indicated that the carelessness factor model was the optimal model, and the factor “feeling worse” was the lowest.Conclusion. The Portuguese version of ITAS has adequate psychometric properties to measure adherence to immunosuppressant therapy.

Factors that determine self-reported immunosuppressant adherence in kidney transplant recipients: a correlational study.

To determine the factors related to immunosuppressant therapy adherence in kidney transplant recipients in Taiwan. Adherence to immunosuppressant treatment is critical after kidney transplantation. Thus, the factors associated with self-reported medication adherence in kidney transplant recipients warrant investigation. The study used a cross-sectional and correlation design. A convenience sample of 145 kidney transplant recipients was included. Structured questionnaires were used to collect data during 2012-2013. Multivariate linear regression was used to examine the factors related to immunosuppressant therapy adherence. Over half of the participants were female (54·5%), mean age was 45·5years, and mean year after transplant was 7·4. The mean score for medication adherence was 29·73 (possible score range 7-35). The results of the multivariate linear regression analysis showed that gender (male), low income with a high school or college education, years after transplantation and concerns about medication taking were negatively associated with adherence. Medication self-efficacy was positively associated with adherence. Therapy-related factors, partnerships with healthcare professionals and having private healthcare insurance did not significantly relate to immunosuppressant therapy adherence. Kidney transplant recipients demonstrated a high level of adherence. Strategies to enhance patients' self-efficacy and alleviate concerns about medication may promote medication adherence. Male patients, those with a lower income and those with a higher education level, should be a focus of efforts to maintain adherence to the medication regimen.

Medication therapy management and adherence among US renal transplant recipients.

BackgroundMedication therapy management (MTM) services among patient populations with a range of disease states have improved adherence rates. However, no published studies have examined the impact of Medicare Part D MTM eligibility on renal transplant recipients’ (RTRs) immunosuppressant therapy (IST) adherence. This study’s purpose was therefore, to determine the effects of Medicare Part D MTM on IST adherence among adult RTRs at 12 months posttransplant.MethodsCross-sectional analyses were performed on Medicare Parts A, B, and D claims and transplant follow-up data reported in the United States Renal Data System. The sample included adult RTRs who were transplanted between 2006 and 2011, had graft survival for 12 months, were enrolled in Part D, and were prescribed tacrolimus. IST adherence was measured by medication possession ratio for tacrolimus. MTM eligibility was determined using criteria established by the Centers for Medicare and Medicaid Services. Descriptive statistics were calculated. Adherence was modeled using multiple logistic regression.ResultsIn all, 17,181 RTRs were included. The majority of the sample were male (59.1%), and 42% were MTM-eligible. Mean medication possession ratio was 0.91±0.17 (mean ± standard deviation), with 16.83% having a medication possession ratio of <0.80. MTM eligibility, sex, age, and number of prescription drugs were significantly associated with adherence in the full model (P<0.05). MTM-eligible RTRs were more likely to be adherent than those who were not MTM-eligible (odds ratio =1.13, 95% confidence interval 1.02–1.26, P=0.02).ConclusionThe findings provide evidence that access to MTM services increases IST adherence among RTRs.

Patient survey to identify reasons for non-adherence and elicitation of quality of life concepts associated with immunosuppressant therapy in kidney transplant recipients.

BackgroundRenal transplantation (RT) is considered the treatment of choice for end-stage renal disease compared to dialysis, offering better health-related quality of life (HRQoL) and higher survival rates. However, immunosuppressants are essential for the long-term survival of kidney grafts and patients’ non-adherence to their medication leads to poor outcomes. Immunosuppressants can also significantly alter patients’ HRQoL because of their side effects and the complex chronic medication regimen they represent.PurposeTo elicit key concepts related to adherence to immunosuppressant therapy (IT) and reasons for non-adherence in terms of patient reported outcomes, side effects, and the impact of the medication on HRQoL in RT population, including patient preference of once daily over twice-daily immunosuppressive regimen. Results were used to develop an IT-specific conceptual framework and provide suggestions for improving patients’ adherence to IT.Materials and methodsInterviews were conducted with three clinical experts to determine key concepts related to RT and immunosuppressants. Thirty-seven participants in four focus groups were asked to cite important concepts related to adherence and impact of IT on HRQoL and to rate them. Qualitative analysis was conducted to code participants’ responses.ResultsNon-adherence among participants where admitted was unintentional. The reason for this included forgetfulness, interference with lifestyle, being asleep at the time the medication should be taken, change in routine, and impact of side effects. Overall, participants reported that the evening dose was more problematic to remember and that the exclusion of this dose could make them more adherent. Participants also reported that IT impacted on their HRQoL in a number of ways including: placing restrictions on their lifestyle, causing anxiety, or impairing their ability to work.ConclusionThis study provides qualitative evidence about the barriers to IT adherence and the components of HRQoL that are important from the perspective of RT patients. The developed conceptual framework of IT-HRQoL in RT transplants, including social, psychological, and work life domains, can be used to inform the development of a new IT-specific measure of HRQoL in RT patients for use in head-to-head clinical trials or observational studies. Despite limitations associated with the number and the age range of patients recruited, this study suggests that a change in the regimen from twice-daily to once daily among other measures could improve their adherence to IT and their HRQoL by placing less restrictions on their lifestyles.

Organ Nakli Alıcıları İçin İmmunosupresif Tedaviye Uyum Ölçeği: Türkçe Geçerlik ve Güvenilirlik Çalışması

Organ Nakli Alıcıları İçin İmmunosupresif Tedaviye Uyum Ölçeği: Türkçe Geçerlik ve Güvenilirlik Çalışması

Immunosuppressive Medication Adherence, Therapeutic Adherence, School Performance, Symptom Experience, and Depression Levels in Patients Having Undergone a Liver Transplant During Childhood.

This study sought to investigate immunosuppressive medication adherence, therapeutic adherence, school performance, symptom experiences, and depression levels of patients having undergone liver transplant during childhood. We performed a retrospective, cross-sectional, case-controlled study to compare the depression levels of subjects with those of their healthy peers. Data were collected between June 23, 2014, and July 10, 2014, from 0- to 18-year-old patients having undergone a liver transplant between 1996 and 2014 (n = 27; the participant's mean age, 17.59 y [SD = 4.29, min-max = 8-28 y]). The mean score for the immunosuppressant therapy adherence was 11.18. To collect the data, the Demographic and Clinical Characteristics Form, Immunosuppressant Therapy Adherence Scale, Therapeutic Regimen Adherence Assessment Questionnaire, School Performance Assessment Questionnaire, Modified Transplant Symptom Occurrence and Symptom Distress Scale-58, and Beck Depression Inventory were used. To analyze the data, descriptive statistics (frequencies, mean, and standard deviation), Mann-Whitney U test, and ridit scoring were used. While the rate of adherence with clinical appointments was 55.5%, it was 33.3% with the diet (prescribed regimen) and 44.4% with exercise. While 33.3% of the participants repeated a grade or were held back, 44.4% of them missed more than 20 school days. Of the symptoms, the recipients mostly experienced anxiety, restlessness, nervousness, fatigue, and difficulty in concentrating. The patients' mean depression score was 7.77 when they were compared to their healthy peers, the difference was not statistically significant (P > .05). In our study, the recipients' adherence with immunosuppressive therapy and clinical appointment was high. This study will provide data for the literature about pediatric liver transplant recipients' adherence with diet and exercise, and physiological and psychological symptoms such as fatigue and anxiety.

Relationship between immunosuppressive medications adherence and quality of life and some patient factors in renal transplant patients in Iran.

Background & Aim:About organ transplant, immunosuppressive medications adherence is a critical issue, because non-adherence to these medications causes rejection, reduces quality of life and increases treatment cost and mortality rate. Among these, the quality of life is deemed very important to evaluate treatment result and also it can be useful for discovering non adherence. The aim this study was to assess the relationship between medication adherence and quality of life and some patient factors in renal transplant patients.Methods:The study was a descriptive-correlational design and was done on renal transplant patients over 18 who had undergone surgery for over 3 months, and were inclined to participate. Sample size was 230 people and sampling was convenience. Quality of life questionnaire in renal transplant patients and Immunosuppressant Therapy Adherence Scale were filled by patients and the data was analyzed by SPSS15 software.Results:It showed that the mean score of quality of life in renal transplant patients was 21.65±4.03 and 57.8% of them did not adhere to immunosuppressive medications. Results of correlation between scores of immunosuppressive medication adherence and Quality of life showed that there were significant correlation in 3 dimensions of 4: health performance (p≤0.0001 & rETA=0.23), social-economic (p=0.001 & rETA=0.15), psychological-spiritual (p=0.011 & rETA=0.15), also logistic test showed significant relationship between immunosuppressive medication adherence and number of transplantation (β=1.04, p= 0.048).Conclusion:According to the results, health care providers i.e. nurses must note to medication adherence as a health enhancement factor while treating and educating to these patients.

A longitudinal assessment of adherence with immunosuppressive therapy following kidney transplantation from the Mycophenolic Acid Observational REnal Transplant (MORE) study.

Nonadherence with immunosuppressive therapy after renal transplantation is a major clinical concern, but longitudinal data are sparse. Adherence data were recorded during the Mycophenolic Acid Observational REnal Transplant (MORE) study to help inform compliance management decisions. Prospective data were analyzed from the four-year, observational MORE study of de novo adult renal transplant recipients receiving mycophenolic acid (MPA) as enteric-coated mycophenolate sodium (EC-MPS) or mycophenolate mofetil (MMF) at 40 US sites under routine management. Adherence was assessed using the Immunosuppressant Therapy Adherence Scale (ITAS): total score 0-12 (12, adherence; <12, nonadherence). A logistic regression model was used to identify factors associated with nonadherence. In total, 808/946 recipients (85.4%) provided ≥1 ITAS score. Nonadherence was reported by 24.8%, 31.5%, 33.0%, 39.8%, 35.4% and 26.4% at months 3, 6, 12, 24, 36 and 48, respectively. Mean ITAS score was higher with EC-MPS vs. MMF at months 24 (11.3[1.0] vs. 10.9[1.4], p=0.001) and 36 (11.4[1.0] vs. 11.1[11.3], p=0.024). The odds ratio for nonadherence was 1.60 (95% CI 1.17, 2.19; p=0.003) for African Americans vs. non-African Americans. The rate of biopsy-proven acute rejection was 12.7% (51/401) in nonadherent recipients vs. 11.3% (46/406) in adherent recipients (p=0.59); graft loss was 4.7% (19/402) vs. 3.0% (12/406) (p=0.20); death was 1.5% (6/402) vs. 4.7% (19/406) (p=0.013). Adherence to the immunosuppressive regimen decreases over time, highlighting the need to monitor and encourage adherence even in long-term maintenance kidney transplant patients. Other than African American race, demographic factors may be of limited value in predicting nonadherence.