Medication Non-adherence among Liver Transplant Recipients
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MANAGEMENT OF THE CIRRHOTIC PATIENT (A CARDENAS AND P TANDON, SECTION EDITORS)
Medication Non-adherence among Liver Transplant Recipients Lauren S. Jones 1,2 & Marina Serper 1,3 Accepted: 7 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review We provide an overview of the recent evidence on the prevalence, risk factors, and consequences of medication non-adherence (NA) in liver transplant (LT) recipients. Recent Findings NA in LT is associated with socio-demographic and medication-related factors, low social support, and poor health literacy. Patient-reported adherence is one of the most common methods to measure NA using validated assessments; immunosuppression (IS) drug levels and electronic monitoring may also be used. Simplification of IS regimens such as the conversion from twice daily to once daily has been shown to be safe, effective, and improves adherence. Relatively few studies have prospectively investigated NA predictors or interventions to reduce NA in LT. Summary Medication non-adherence is a multi-faceted issue that is common among LT recipients and associated with adverse outcomes. NA in LT recipients warrants further study as only a few interventions have been published focused on reducing NA in LT. Keywords Immunosuppression; outcomes . Electronic monitoring . Compliance . Self-care . Rejection . Tacrolimus standard deviation
Introduction Over the last few decades, long-term outcomes in liver transplantation (LT) have continued to improve with advances in surgical techniques, immunosuppression (IS) management, and careful candidate selection. Given these trends, medication non-adherence (NA) post-transplant is a leading cause of graft rejection, graft failure, and poor long-term outcomes [1–3]. Adherence is generally defined as the extent to which patient behavior matches agreed-upon provider recommendations. In the LT population, NA to IS medication is common (15–40%) though slightly lower than in the general population where NA is about 50%. Etiologies of NA are multi-factorial and may be related to patient factors (e.g., forgetfulness) as well as medical This article is part of the Topical Collection on Management of the Cirrhotic Patient * Marina Serper [email protected] 1
Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
2
Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
3
Philadelphia, USA
regimen complexity, frequently changing drug doses, possible side effects, and financial barriers. Additionally, pre-transplant psychiatric comorbidities and lack of social support play important roles in post-transplant adherence [4, 5]. Although precise estimates are not widely available, NA is associated with about 25% increased risk for graft loss and increased post-transplant hospitalizations [6]. The recognition of NA by clinicians is challenging as patients may not generally volunteer that they may be experiencing medication i
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