+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Medication misuse, nonadherence, and clinical outcomes among liver transplant recipients

Medication misuse, nonadherence, and clinical outcomes among liver transplant recipients

Liver Transplantation 21(1): 22-28

Medication nonadherence after liver transplantation (LT) is associated with adverse clinical outcomes such as graft rejection and graft loss. Few studies have examined nonadherence and its impact on clinical outcomes in LT. The study objectives were (1) to evaluate medication understanding (with treatment knowledge and demonstrated regimen use scores) and medication adherence or nonadherence to entire regimens among LT recipients and (2) to examine associations of these exposures with clinical outcomes. We conducted a 2-site study of 105 recipients between 2011 and 2012 at 2 transplant centers in Chicago, IL and Atlanta, GA. Data were collected via detailed, in-person interviews and medical record reviews. Study participants were middle-aged and predominantly male; 15% of the sample had limited literacy. On average, patients were taking 11 medications [standard deviation (SD) = 4], and 39% had undergone a medication change within the last month. The average scores for the entire medication regimen were 86% (SD = 22%) for treatment knowledge and 78% (SD = 22%) for demonstrated regimen use. The mean score for self-reported nonadherence to the entire regimen was 14% (SD = 20%), whereas 32% of the patients were nonadherent according to tacrolimus levels. In multivariate analyses, lower income, less time since transplantation, a higher number of medications, and limited literacy were inversely associated with treatment knowledge scores (all P < 0.05), whereas limited literacy was associated with nonadherence according to tacrolimus levels (P < 0.05). In multivariate models, higher scores for treatment knowledge [incidence rate ratio (IRR) = 0.85, 95% confidence interval (CI) = 0.74-0.97] and demonstrated regimen use (IRR = 0.87, 95% confidence interval = 0.77-0.98) were independently associated with 15% and 13% reductions in the number of posttransplant rehospitalizations, respectively. Inadequate treatment knowledge and improper regimen use may be significant determinants of unintentional nonadherence among LT recipients and are associated with adverse clinical outcomes.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 054314184

Download citation: RISBibTeXText

PMID: 25312406

DOI: 10.1002/lt.24023

Related references

Describing the evolution of medication nonadherence from pretransplant until 3 years post-transplant and determining pretransplant medication nonadherence as risk factor for post-transplant nonadherence to immunosuppressives: the Swiss Transplant Cohort Study. Transplant International 27(7): 657-666, 2014

Medication level variability index predicts rejection, possibly due to nonadherence, in adult liver transplant recipients. Liver Transplantation 20(10): 1168-1177, 2014

Medication errors: an important component of nonadherence to medication in an outpatient population of lung transplant recipients. American Journal of Transplantation 7(11): 2561-2566, 2007

Prevalence of Medication Nonadherence to Co-medication Compared to Immunosuppressants in Heart Transplant Recipients: Findings From the International Cross-sectional BRIGHT Study. Clinical Therapeutics 41(1): 130-136, 2019

Factors associated with nonadherence to medication in kidney transplant recipients. Nephron. Clinical Practice 117(1): C33-C39, 2011

Cost-related immunosuppressive medication nonadherence among kidney transplant recipients. Clinical Journal of the American Society of Nephrology 5(12): 2323-2328, 2010

Associations Between Medication Nonadherence and Perceived Stress Among Kidney Transplant Recipients. Progress in Transplantation 27(4): 396-397, 2017

Intragraft B-Cells Are Associated with Medication Nonadherence and Severity of Rejection in Pediatric Kidney Transplant Recipients. Transplantation Journal 94(10s): 71-72, 2012

Medication understanding, non-adherence, and clinical outcomes among adult kidney transplant recipients. Clinical Transplantation 30(10): 1294-1305, 2016

The prevalence, risk factors, and outcomes of medication trade-offs in kidney and liver transplant recipients: a pilot study. Transplant International 31(8): 870-879, 2018

Medication barriers predict adolescent transplant recipients' adherence and clinical outcomes at 18-month follow-up. Journal of Pediatric Psychology 35(9): 1038-1048, 2010

Risk factors and clinical outcomes of pediatric liver transplant recipients with post-transplant lymphoproliferative disease in a multi-ethnic Asian cohort. Transplant Infectious Disease 20(1):, 2018

Medication errors and adverse drug events in kidney transplant recipients: incidence, risk factors, and clinical outcomes. PharmacoTherapy 32(12): 1053-1060, 2012

Beyond the NIH Multicenter HIV Transplant Trial Experience: Outcomes of HIV+ Liver Transplant Recipients Compared to HCV+ or HIV+/HCV+ Coinfected Recipients in the United States. Clinical Infectious Diseases 61(7): 1054-1062, 2015

A pilot study of posttraumatic stress and nonadherence in pediatric liver transplant recipients. Pediatrics 105(2): E29, 2000