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Vitinius F, Reklat A, Hellmich M, Klask E, Wahlers T, Rahmanian PB, Pfister R, Müller-Ehmsen J, Albus C. Prediction of survival on the waiting list for heart transplantation and of posttransplant nonadherence-Results of a prospective longitudinal study. Clin Transplant 2019; 33:e13616. [PMID: 31136011 DOI: 10.1111/ctr.13616] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 05/16/2019] [Accepted: 05/22/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Only a few previous studies have focused on the interaction between pretransplant psychological variables, survival on the waiting list, and adherence to therapy after heart transplantation (HTx). METHODS This work combined two studies: Study 1 monitored survival of patients on a HTx waiting list (n = 50) and study 2 examined barriers to adherence after HTx (subgroup of n = 20). All patients were evaluated immediately after listing for HTx (T0). Those in study 2 were also evaluated immediately after HTx (T1) and after 6 months (T2). Psychosocial functioning was measured by the Transplant Evaluation Rating Scale (TERS), and depression and anxiety by Patient Health Questionnaire and Hospital Anxiety and Depression Scale. Barriers to immunosuppressive adherence post-HTx were measured by the Medication Experience Scale for Immunosuppressants (MESI). RESULTS According to the TERS classification of Rothenhäusler et al, patients were divided into three groups in study 1. Compared with inconspicuous patients (n = 23) and risk patients (n = 21), high-risk patients (n = 6) demonstrated a higher mortality (log-rank test of trend, P = 0.002). In study 2, there was a strong correlation between the TERS (T0) and the MESI (T2) (r = 0.84, P = 0.001). CONCLUSIONS The TERS may serve as a predictor of survival on the waiting list. There is need for further longitudinal data with larger sample sizes.
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Affiliation(s)
- Frank Vitinius
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Andre Reklat
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elisa Klask
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Parwis B Rahmanian
- Department of Cardiothoracic Surgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department of Internal Medicine III (Cardiology), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
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52
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Annette L, Annika K, Anna F. Non-adherence to Immunosuppressant after Lung Transplantation – A Common Risk Behavior. Open Nurs J 2019. [DOI: 10.2174/1874434601913010108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background:
After lung transplantation, life-long treatment with immunosuppressive medication is required to prevent rejection and graft loss but adherence to immunosuppressive treatment may be difficult for the lung recipient. Adherence is essential and non-adherence to immunosuppressive treatment can lead to graft loss and death.
Objective:
The aim of this cross-sectional study was to investigate the prevalence of non-adherence 1 to 5 years after lung transplantation in relation to symptom burden, health literacy, psychological well-being and relevant demographic variables.
Methods:
117 adult lung recipients, due for their annual follow-up 1-5 years after lung transplantation, participated. Four self-report instruments were used for assessment: the Basel Assessment of Adherence with Immunosuppressive Medication Scale, the Newest Vital Sign, the Psychological General Well-Being and the Organ Transplant Symptom and Wellbeing Instrument. Statistical analysis was performed.
Results:
Thirty percent of the lung recipients were non-adherent. The most common non-adherence dimension was not taking a dose (43%) and not being punctual with the regimen (80%). Of those working full time or part time, 43% were non-adherent (p=.032). A higher level of non-adherence was reported a long time after LuTx with the highest level at the 3-year follow-up.
Conclusion:
The level of non-adherence among lung recipients was high. The highest levels were found among those who had returned to work. Non-adherence increased with time after lung transplantation.
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53
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Been-Dahmen JMJ, Beck DK, Peeters MAC, van der Stege H, Tielen M, van Buren MC, Ista E, van Staa A, Massey EK. Evaluating the feasibility of a nurse-led self-management support intervention for kidney transplant recipients: a pilot study. BMC Nephrol 2019; 20:143. [PMID: 31029107 PMCID: PMC6486974 DOI: 10.1186/s12882-019-1300-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 03/18/2019] [Indexed: 12/14/2022] Open
Abstract
Background To support effective self-management after kidney transplantation, a holistic nurse-led self-management support intervention was developed using the Intervention Mapping approach. The primary aim was to evaluate the feasibility, acceptability and fidelity of the intervention for kidney transplant recipients and professionals. The secondary aim was to explore preliminary effects on outcomes. Methods A pilot study was conducted in 2015–2017 to evaluate the intervention. Nurse Practitioners (NP) guided recipients in assessing 14 life areas using the Self-Management Web. Participants were supported in developing self-regulation skills which can be applied to self-management of the illness. Strategies included goal setting, action planning, and promotion of motivation and self-efficacy. Adult recipients from an outpatient clinic of a Dutch University Hospital who underwent their transplant at least 1 month ago, were invited to participate. NPs, nephrologists and recipients were interviewed to assess feasibility, fidelity and implementation experience. Consultations were videoed and analysed to assess fidelity. To assess the preliminary effects, the intervention group completed baseline (T0) and follow-up (T1) questionnaires on self-management behavior, self-efficacy, quality of life and quality of care. A historical control group of kidney transplant recipients completed the same questionnaires at T1. Results Twenty-seven recipients agreed to participate in the intervention group, of which 24 completed the intervention and 16 completed baseline and follow-up surveys. The control group consisted of 33 recipients. Professionals and recipients appraised the open, holistic focus of the intervention as a welcome addition to standard care and felt that this helped to build a relationship of trust. Recipients also felt they became more competent in problem-solving skills. The within-group analysis showed no significant increase in patients’ self-management skills. The between-groups analysis showed significantly higher medication adherence among the intervention group (P = 0.03; G = 0.81). The within-groups analysis showed a significantly higher perceived quality of care (P = 0.02) in the intervention group. Conclusion This holistic nurse-led self-management support intervention was found to be feasible and acceptable by professionals and recipients alike. This pilot had a small sample therefore further research is needed into the potential effects on self-management behavior and well-being of transplant recipients. ISRCTN Trial Registry: ISRCTN15057632 (registered retrospectively on 20-07-2018). Electronic supplementary material The online version of this article (10.1186/s12882-019-1300-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Janet M J Been-Dahmen
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001, Rotterdam, HA, the Netherlands.,Department of Internal Medicine - Section Nephrology & Transplantation, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands
| | - Denise K Beck
- Department of Internal Medicine - Section Nephrology & Transplantation, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands
| | - Mariëlle A C Peeters
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001, Rotterdam, HA, the Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, Rotterdam, DR, the Netherlands
| | - Heleen van der Stege
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001, Rotterdam, HA, the Netherlands
| | - Mirjam Tielen
- Department of Internal Medicine - Section Nephrology & Transplantation, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands
| | - Marleen C van Buren
- Department of Internal Medicine - Section Nephrology & Transplantation, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands
| | - Erwin Ista
- Department of Internal Medicine - Section Nursing Science, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands.,Intensive Care Unit, Erasmus MC University Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000, Rotterdam, DR, the Netherlands
| | - AnneLoes van Staa
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001, Rotterdam, HA, the Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, Rotterdam, DR, the Netherlands
| | - Emma K Massey
- Department of Internal Medicine - Section Nephrology & Transplantation, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands.
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Tohidinezhad F, Aliakbarian M, Abu-Hanna A, Eslami S. Development and Psychometric Testing of Liver Transplant Therapeutic Adherence Questionnaire in a Triphasic Mixed-Method Study. Prog Transplant 2019; 29:122-128. [PMID: 30961420 DOI: 10.1177/1526924819835824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Due to the high nonadherence rate to posttransplant regimen and medical indications among liver transplant recipients, systematic patient-centered interventions are needed to improve the medium- and long-term graft and patient survival outcomes. OBJECTIVE The aim of this study was to develop and test the psychometric properties of Liver Transplant Therapeutic Adherence Questionnaire. DESIGN A mixed-method instrument design was conducted in 3 phases: (1) initial item collection was generated by inductive content analysis on internationally available resources, (2) item screening was carried out by a 3-member committee and 25 domain experts including nurses and physicians aiming to establish content validity, and (3) data were collected from 247 liver transplant recipients in May 2016 for psychometric testing. RESULTS A total of 221 knowledge statements were extracted as potential adherence assessment items. The qualitative screening phase resulted in top 35 important items. The second screening phase was performed quantitatively by 25 experts (n = 14 nurses, n = 7 gastroenterologists and hepatologists, and n = 4 transplant surgeons). A total of 16 items were associated with statistically significant content validity ratio values (≥0.37) to be included in the final questionnaire. Exploratory factor analysis revealed a distinct 4-factor structure that was labeled as: daily activities (α = .93), immunization (α = .93), nutrition (α = .92), and major complications (α = .79). DISCUSSION Our results reveal evidence of acceptable reliability and validity for Liver Transplant Therapeutic Adherence Questionnaire. This instrument makes it possible to measure recipients' therapeutic adherence in both domains of research and practice.
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Affiliation(s)
- Fariba Tohidinezhad
- 1 Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Aliakbarian
- 2 Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ameen Abu-Hanna
- 3 Department of Medical Informatics, University of Amsterdam, Amsterdam, the Netherlands
| | - Saeid Eslami
- 4 Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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55
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Zhao SM, Dong FF, Qiu HZ, Li D. Quality of Life, Adherence Behavior, and Social Support Among Renal Transplant Recipients in China: A Descriptive Correlational Study. Transplant Proc 2018; 50:3329-3337. [PMID: 30577203 DOI: 10.1016/j.transproceed.2018.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/23/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Quality of life (QoL) is an important indicator for evaluating therapeutic outcomes and mortality in renal transplant recipients, but there is scarce information regarding QoL, adherence behavior, social support and their relationships. This study assessed these factors among renal transplant recipients. METHODS Using a descriptive, correlational, cross-sectional design, this study included a convenience sample of 253 kidney transplant recipients. Structured questionnaires were used to collect data. RESULTS The scores on QoL domains (except the social functioning domain [P = .909]) were lower in our recipients than in the general Chinese population norm (P = .0000001). Time since transplantation (P = .041) and education (P = .013) were factors affecting QoL scores. The mean total adherence behavior score was 60.64 ± 7.71. Occupation and time since transplantation affected the total adherence behavior score. There was an alarming percentage of nonadherence in our transplant recipients (27.5%-72.3%). The mean total social support score was 40.76 ± 9.51. The total social support score (P = .0000087) was lower than the general Chinese population norm. Occupation (P = .0000087) education (P = .010), marital status (P = .013), payment method (P = .028) and monthly income (P = .007) affected the total social support score; there were significant relationships between physical health, psychological health, adherence behavior (r = .145, P = .022; r = .153, P = .016), and social support (r = .211, P = .001; r = .301, P = .000). CONCLUSIONS The findings demonstrate somewhat deficient QoL among renal transplant recipients compared with the general population. Social support, adherence behavior, time since transplantation and education significantly influenced QoL for our recipients, and social support had the most significant influence on adherence behavior and QoL.
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Affiliation(s)
- S M Zhao
- Department of Nursing, First Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, People's Republic of China.
| | - F F Dong
- Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, People's Republic of China
| | - H Z Qiu
- Department of Renal Transplantation, First Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, People's Republic of China
| | - D Li
- Department of Renal Transplantation, First Affiliated Hospital, Xi'an Jiaotong University, Shaanxi, People's Republic of China
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56
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Cossart AR, Staatz CE, Campbell SB, Isbel NM, Cottrell WN. Investigating barriers to immunosuppressant medication adherence in renal transplant patients. Nephrology (Carlton) 2018; 24:102-110. [DOI: 10.1111/nep.13214] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2017] [Indexed: 12/11/2022]
Affiliation(s)
| | | | - Scott Bryan Campbell
- Department of NephrologyUniversity of Queensland at the Princess Alexandra Hospital Brisbane Australia
| | - Nicole Maree Isbel
- Department of NephrologyUniversity of Queensland at the Princess Alexandra Hospital Brisbane Australia
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57
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Dew MA, DiMartini AF, Dobbels F, Grady KL, Jowsey-Gregoire SG, Kaan A, Kendall K, Young QR, Abbey SE, Butt Z, Crone CC, De Geest S, Doligalski CT, Kugler C, McDonald L, Ohler L, Painter L, Petty MG, Robson D, Schlöglhofer T, Schneekloth TD, Singer JP, Smith PJ, Spaderna H, Teuteberg JJ, Yusen RD, Zimbrean PC. The 2018 ISHLT/APM/AST/ICCAC/STSW Recommendations for the Psychosocial Evaluation of Adult Cardiothoracic Transplant Candidates and Candidates for Long-term Mechanical Circulatory Support. PSYCHOSOMATICS 2018; 59:415-440. [DOI: 10.1016/j.psym.2018.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/09/2018] [Indexed: 12/28/2022]
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58
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Been‐Dahmen JMJ, Grijpma JW, Ista E, Dwarswaard J, Maasdam L, Weimar W, Van Staa A, Massey EK. Self‐management challenges and support needs among kidney transplant recipients: A qualitative study. J Adv Nurs 2018; 74:2393-2405. [DOI: 10.1111/jan.13730] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/14/2018] [Accepted: 04/04/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Janet M. J. Been‐Dahmen
- Research Center Innovations in Care Rotterdam University of Applied Sciences Rotterdam The Netherlands
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
| | - Jan Willem Grijpma
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
| | - Erwin Ista
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
- Intensive Care Unit Erasmus MC University Medical Center‐Sophia Children's Hospital Rotterdam The Netherlands
| | - Jolanda Dwarswaard
- Research Center Innovations in Care Rotterdam University of Applied Sciences Rotterdam The Netherlands
| | - Louise Maasdam
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
| | - Willem Weimar
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
| | - AnneLoes Van Staa
- Research Center Innovations in Care Rotterdam University of Applied Sciences Rotterdam The Netherlands
| | - Emma K. Massey
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
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Dew MA, DiMartini AF, Dobbels F, Grady KL, Jowsey-Gregoire SG, Kaan A, Kendall K, Young QR, Abbey SE, Butt Z, Crone CC, De Geest S, Doligalski CT, Kugler C, McDonald L, Ohler L, Painter L, Petty MG, Robson D, Schlöglhofer T, Schneekloth TD, Singer JP, Smith PJ, Spaderna H, Teuteberg JJ, Yusen RD, Zimbrean PC. The 2018 ISHLT/APM/AST/ICCAC/STSW recommendations for the psychosocial evaluation of adult cardiothoracic transplant candidates and candidates for long-term mechanical circulatory support. J Heart Lung Transplant 2018; 37:803-823. [PMID: 29709440 DOI: 10.1016/j.healun.2018.03.005] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 12/11/2022] Open
Abstract
The psychosocial evaluation is well-recognized as an important component of the multifaceted assessment process to determine candidacy for heart transplantation, lung transplantation, and long-term mechanical circulatory support (MCS). However, there is no consensus-based set of recommendations for either the full range of psychosocial domains to be assessed during the evaluation, or the set of processes and procedures to be used to conduct the evaluation, report its findings, and monitor patients' receipt of and response to interventions for any problems identified. This document provides recommendations on both evaluation content and process. It represents a collaborative effort of the International Society for Heart and Lung Transplantation (ISHLT) and the Academy of Psychosomatic Medicine, American Society of Transplantation, International Consortium of Circulatory Assist Clinicians, and Society for Transplant Social Workers. The Nursing, Health Science and Allied Health Council of the ISHLT organized a Writing Committee composed of international experts representing the ISHLT and the collaborating societies. This Committee synthesized expert opinion and conducted a comprehensive literature review to support the psychosocial evaluation content and process recommendations that were developed. The recommendations are intended to dovetail with current ISHLT guidelines and consensus statements for the selection of candidates for cardiothoracic transplantation and MCS implantation. Moreover, the recommendations are designed to promote consistency across programs in the performance of the psychosocial evaluation by proposing a core set of content domains and processes that can be expanded as needed to meet programs' unique needs and goals.
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Affiliation(s)
- Mary Amanda Dew
- University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania, USA.
| | - Andrea F DiMartini
- University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Kathleen L Grady
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Annemarie Kaan
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | | | - Susan E Abbey
- University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Zeeshan Butt
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Sabina De Geest
- Katholieke Universiteit Leuven, Leuven, Belgium; University of Basel, Basel, Switzerland
| | | | | | - Laurie McDonald
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Linda Ohler
- George Washington University, Washington, DC, USA
| | - Liz Painter
- Auckland City Hospital, Auckland, New Zealand
| | | | - Desiree Robson
- St. Vincent's Hospital, Sydney, New South Wales, Australia
| | | | | | - Jonathan P Singer
- University of California at San Francisco, San Francisco, California, USA
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Dew MA, Posluszny DM, DiMartini AF, Myaskovsky L, Steel JL, DeVito Dabbs AJ. Posttransplant Medical Adherence: What Have We Learned and Can We Do Better? CURRENT TRANSPLANTATION REPORTS 2018; 5:174-188. [PMID: 30416933 DOI: 10.1007/s40472-018-0195-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Purpose of review Non-adherence to the medical regimen after kidney transplantation can contribute to poor clinical outcomes, and strategies to maximize adherence are sought by care providers and patients alike. We assessed recent evidence on prevalence, risk factors, and clinical outcomes associated with non-adherence to the medical regimen after kidney transplantation. We summarized recent clinical trials testing interventions to improve adherence and generated recommendations for future research and clinical practice. Recent findings A large evidence base documents rates of non-adherence to each of the multiple components of the regimen, including medication-taking, lifestyle activities, clinical care requirements, and substance use restrictions. Some risk factors for non-adherence are well known but the full range of risk factors remains unclear. Non-adherence to immunosuppressants and to other components of the regimen increases morbidity and mortality risks. Recent interventions, including education and counseling; electronic health strategies; and medication dose modifications, show promise for reducing immunosuppressant non-adherence. However, most of these interventions would be difficult to deploy in everyday clinical practice. Systematic dissemination of efficacious interventions into clinical practice has not been undertaken. Summary Rates and risk factors for non-adherence to the medical regimen have been examined and there is evidence that non-adherence may be ameliorated by a range of interventions. Although gaps in the evidence base remain, it would be timely to devote greater efforts to dissemination of findings. Thus, efforts are needed to assist transplant programs in using existing evidence to better identify patients who are non-adherent and to design and implement strategies to reduce or prevent non-adherence.
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Affiliation(s)
- Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.,Departments of Psychiatry, Psychology, Epidemiology, Biostatistics, and the Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Donna M Posluszny
- Department of Medicine and University of Pittsburgh Medical Center Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrea F DiMartini
- Departments of Psychiatry and Surgery and the Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Larissa Myaskovsky
- Department of Internal Medicine, Nephrology Division, and the Center for Healthcare Equity in Kidney Disease, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Jennifer L Steel
- Departments of Surgery, Psychiatry, and Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Annette J DeVito Dabbs
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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Abstract
Introduction: Although self-management is essential for liver transplant recipients, there is no review that has synthesized findings related to self-management in this population. Objective: This narrative review aimed to synthesize the current findings and identify the gaps in knowledge about self-management in liver recipients. Methods: A search of PubMed, CINAHL Plus, PsychINFO, ProQuest, and Web of Science was conducted using the following terms: [Self-care OR Self-management OR Health behavior] AND [Liver transplantation]. Peer-reviewed published research articles focusing on self-management of adult recipients were selected. A total of 23 articles were included for review. Two reviewers independently reviewed the full text of selected articles and extracted the data about definitions, measurements, and findings regarding self-management. Results: Three areas of self-management were identified, including medication nonadherence (n = 11), alcohol recidivism (n = 11), and health maintenance (n = 5). Reported rates of medication nonadherence ranged from 8% to 66%. Medication nonadherence was related to recipients’ demographic (eg, age or sex), transplant-related (eg, time since transplant), and pretransplant variables (eg, history of substance/alcohol abuse). Reported alcohol recidivism rates ranged from 3% to 95%. Age, pretransplant variables (eg, abstinent time before transplant), and personality disorder were identified to be related to alcohol recidivism after transplant. The health maintenance studies discussed behaviors such as smoking, clinic appointment attendance, or vaccination/health screening behaviors of recipients. Discussion: Self-management studies in liver recipients have been narrowly focused on medication nonadherence and alcohol recidivism. To improve self-management in recipients, self-management beyond medication nonadherence and alcohol recidivism should be comprehensively examined.
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Affiliation(s)
- Dami Ko
- School of Nursing, University of Wisconsin–Madison, Madison, WI, USA
| | | | - Lisa C. Bratzke
- School of Nursing, University of Wisconsin–Madison, Madison, WI, USA
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High Intrapatient Variability of Tacrolimus Exposure in the Early Period After Liver Transplantation Is Associated With Poorer Outcomes. Transplantation 2018; 102:e108-e114. [DOI: 10.1097/tp.0000000000002052] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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63
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Drick N, Seeliger B, Fuge J, Tudorache I, Greer M, Welte T, Haverich A, Gottlieb J. Self-reported non-adherence to immunosuppressive medication in adult lung transplant recipients-A single-center cross-sectional study. Clin Transplant 2018; 32:e13214. [DOI: 10.1111/ctr.13214] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Nora Drick
- Department of Respiratory Medicine; Hannover Medical School; Hannover Germany
| | - Benjamin Seeliger
- Department of Respiratory Medicine; Hannover Medical School; Hannover Germany
| | - Jan Fuge
- Member of the German Center for Lung Research (DZL); Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH); Hannover Germany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplantation and Vascular Surgery; Hannover Medical School; Hannover Germany
| | - Mark Greer
- Department of Respiratory Medicine; Hannover Medical School; Hannover Germany
- Member of the German Center for Lung Research (DZL); Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH); Hannover Germany
| | - Tobias Welte
- Department of Respiratory Medicine; Hannover Medical School; Hannover Germany
- Member of the German Center for Lung Research (DZL); Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH); Hannover Germany
| | - Axel Haverich
- Member of the German Center for Lung Research (DZL); Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH); Hannover Germany
- Department of Cardiothoracic, Transplantation and Vascular Surgery; Hannover Medical School; Hannover Germany
| | - Jens Gottlieb
- Department of Respiratory Medicine; Hannover Medical School; Hannover Germany
- Member of the German Center for Lung Research (DZL); Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH); Hannover Germany
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Leite RF, Silva ACM, Oliveira PCD, Silva LMGD, Pestana JMDA, Schirmer J, Roza BDA. Mensuração da adesão aos medicamentos imunossupressores em receptores de transplante renal. ACTA PAUL ENFERM 2018. [DOI: 10.1590/1982-0194201800069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Resumo Objetivo: Mensurar a adesão aos medicamentos imunossupressores em receptores de transplante renal, utilizando a Basel Assessment of Adherence with Immunosuppressive Medication Scale - BAASIS® e descrever as características sociodemográficas, os fatores clínicos em relação aos imunossupressores e os níveis de creatinina. Métodos: Estudo prospectivo, transversal, realizado no período de 2014 a 2015, no Ambulatório Pós-Transplante do Hospital do Rim (complexo hospitalar da Universidade Federal de São Paulo (UNIFESP)). Resultados: Dos 181 participantes, 53,6% eram homens e a idade dos receptores variou de 18 a 74 anos. A Hipertensão Arterial Sistêmica foi o diagnóstico inicial de Insuficiência Renal Crônica em 38,7% dos receptores. Aproximadamente 95% dos receptores relataram que nunca se esqueceram de tomar o medicamento; 58,6% dos pacientes relataram ter aderido totalmente aos imunossupressores e 41,4% não aderiram a uma ou mais das quatro situações avaliadas pelos itens da BAASIS®. Não foi encontrada correlação significativa pelos itens da BAASIS® entre os níveis de creatinina e o escore total. Conclusão: Foi identificado um alto índice de pacientes que não aderiram ao tratamento imunossupressor (41,4%). Não houve correlação significativa entre o nível de creatinina e a idade do receptor no momento do TxR, bem como o tempo após TxR, tempo de separação do imunossupressor e escore total, e escores dos itens individuais da BAASIS®. Esse estudo mostrou que os receptores negros, do sexo masculino, sem uma rede de apoio familiar, obesos e autônomos são mais propensos a não aderir à terapia imunossupressora. A avaliação da adesão do receptor de transplante renal deve ser considerada durante todas as fases das ações do processo de enfermagem que compõem o plano terapêutico após o transplante renal.
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Dobbels F, Vanhoof J, Schoemans H, Duerinckx N, Verbeeck I, De Geest S. Improving medication adherence: The proof of the pudding will be in the eating. Liver Transpl 2018; 24:9-11. [PMID: 29194957 DOI: 10.1002/lt.24988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/27/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Fabienne Dobbels
- Academic Center for Nursing and Midwifery KU Leuven, Leuven, Belgium.,Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Jasper Vanhoof
- Academic Center for Nursing and Midwifery KU Leuven, Leuven, Belgium
| | - Hélène Schoemans
- Academic Center for Nursing and Midwifery KU Leuven, Leuven, Belgium.,Department of Hematology and
| | - Nathalie Duerinckx
- Academic Center for Nursing and Midwifery KU Leuven, Leuven, Belgium.,Heart Transplant Program, University Hospitals of Leuven, Leuven, Belgium
| | - Ive Verbeeck
- Academic Center for Nursing and Midwifery KU Leuven, Leuven, Belgium
| | - Sabina De Geest
- Academic Center for Nursing and Midwifery KU Leuven, Leuven, Belgium.,Institute of Nursing Science, University of Basel, Basel, Switzerland
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Vankova B, Mala-Ladova K, Kubena AA, Maly J, Sulkova SD. Immunosuppressive therapy related adherence, beliefs and self-management in kidney transplant outpatients. Patient Prefer Adherence 2018; 12:2605-2613. [PMID: 30584284 PMCID: PMC6287542 DOI: 10.2147/ppa.s184166] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Kidney transplant (KTx) recipients should strictly adhere to their lifelong complex therapeutic regimen, and any barriers to medication adherence can weaken correct patient behavior. This study aimed to determine the adherence to immunosuppressive therapy (IS) in KTx adult outpatients in the Czech Republic, and attempted to gain a greater insight into their attitudes toward IS and self-management tasks. MATERIALS AND METHODS Pharmacist-led structured interviews were conducted to assess self-reported adherence to IS using the Czech version of the Medication Adherence Report Scale, in the context of attitudes toward IS in terms of necessity and concern scale of the Beliefs about Medicines Questionnaire. A specific questionnaire was developed to target IS self-management tasks. Medication records were also reviewed for IS serum levels, reflecting direct adherence measurement. Descriptive statistics were used to calculate adherence and self-management variables, and were analyzed by univariate and multivariate correlations, including the decision-tree method. RESULTS The interview was completed by 211 (male 123; mean age 55.0±12.4 years, mean time 6.6±5.9 years after KTx) of the total of 235 patients. Full adherence to IS was reported by 173 (82.0%) patients. Most of them had IS serum levels within the therapeutic range, however, cyclosporine was associated with the highest variability (P<0.001). Non-adherence and concerns increased over time after KTx (P<0.05). Despite the more common unintentional non-adherence (P<0.001), relatively high concerns signified the risk of not taking IS as prescribed. Concerns also correlated with the perception of impaired health status (P<0.01), as well as the occurrence of IS-related adverse effects (P<0.001). The patients' awareness of their therapy was insufficient, and main gaps in self-management comprised inadequate sun protection, incorrect administration of IS, and unfamiliarity with the IS name, or their indications. CONCLUSION Although self-reported adherence to IS therapy was satisfactory, the comprehensive evaluation enabled the detection of greater concerns about IS, as well as underestimated self-management tasks that posttransplant interventions should target in the future.
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Affiliation(s)
- Barbora Vankova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic,
| | - Katerina Mala-Ladova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic,
| | - Ales Antonin Kubena
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic,
| | - Josef Maly
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic,
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Benson AA, Rowe M, Eid A, Bluth K, Merhav H, Khalaileh A, Safadi R. Pre-liver transplant psychosocial evaluation predicts post-transplantation outcomes. PSYCHOL HEALTH MED 2017; 23:788-796. [PMID: 29278010 DOI: 10.1080/13548506.2017.1417610] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Psychosocial factors greatly impact the course of patients throughout the liver transplantation process. A retrospective chart review was performed of patients who underwent liver transplantation at Hadassah-Hebrew University Medical Center between 2002 and 2012. A composite psychosocial score was computed based on the patient's pre-transplant evaluation. Patients were divided into two groups based on compliance, support and insight: Optimal psychosocial score and Non-optimal psychosocial score. Post-liver transplantation survival and complication rates were evaluated. Out of 100 patients who underwent liver transplantation at the Hadassah-Hebrew University Medical Center between 2002 and 2012, 93% had a complete pre-liver transplant psychosocial evaluation in the medical record performed by professional psychologists and social workers. Post-liver transplantation survival was significantly higher in the Optimal group (85%) as compared to the Non-optimal group (56%, p = .002). Post-liver transplantation rate of renal failure was significantly lower in the Optimal group. No significant differences were observed between the groups in other post-transplant complications. A patient's psychosocial status may impact outcomes following transplantation as inferior psychosocial grades were associated with lower overall survival and increased rates of complications. Pre-liver transplant psychosocial evaluations are an important tool to help predict survival following transplantation.
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Affiliation(s)
- Ariel A Benson
- a Liver Unit, Institute of Gastroenterology and Liver Diseases, Department of Medicine , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| | - Mina Rowe
- a Liver Unit, Institute of Gastroenterology and Liver Diseases, Department of Medicine , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| | - Ahmad Eid
- b Department of General Surgery and Transplantation Unit , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| | - Keren Bluth
- c Department of Social Workers , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| | - Hadar Merhav
- b Department of General Surgery and Transplantation Unit , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| | - Abed Khalaileh
- b Department of General Surgery and Transplantation Unit , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| | - Rifaat Safadi
- a Liver Unit, Institute of Gastroenterology and Liver Diseases, Department of Medicine , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
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Senft Y, Kirsch M, Denhaerynck K, Dobbels F, Helmy R, Russell CL, Berben L, De Geest S. Practice patterns to improve pre and post-transplant medication adherence in heart transplant centres: a secondary data analysis of the international BRIGHT study. Eur J Cardiovasc Nurs 2017; 17:356-367. [PMID: 29231747 DOI: 10.1177/1474515117747577] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND As medication non-adherence is a major risk factor for poor post-transplant outcomes, we explored how adherence is assessed, enhanced and integrated across the transplant continuum. AIM The aim of this study was to study practice patterns regarding pre- and post-transplant medication adherence assessment and interventions in international heart transplant centres. METHODS We used data from the Building Research Initiative Group: chronic illness management and adherence in heart transplantation (BRIGHT) study, a cross-sectional study conducted in 36 heart transplant centres in 11 countries. On a 27-item questionnaire, 100 clinicians (range one to five per centre) reported their practice patterns regarding adherence assessment and intervention strategies pre-transplant, immediately post-transplant, less than one year, and one or more year post-transplant. Educational/cognitive, counselling/behavioural and psychosocial/affective strategies were assessed. Clinicians' responses (intervention present vs. absent; or incongruence in reporting intervention) were aggregated at the centre level. RESULTS The adherence assessment method most commonly used along the transplant continuum was questioning patients (range 75-88.9%). Pre-transplant, all three categories of intervention strategy were applied. Providing reading materials (82.9%) or instructions (68.6%), involving family or support persons in education (91.4%), and establishing partnership (91.4%) were used most frequently. Post-transplant, strategies closely resembled those employed pre-transplant. Training patients (during recovery) and cueing were more often applied during hospitalisation (74.3%). After the first year post-transplant, except for motivational interviewing (25.7-28.6%), the number of strategies decreased. CONCLUSIONS Across the transplant continuum, diverse adherence interventions are implemented; however, post-transplant, the frequency of adherence interventions decreases. Therefore, increased investment is necessary in long-term adherence interventions.
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Affiliation(s)
- Yuliya Senft
- 1 Department of Haematology, University Hospital of Basel, Switzerland
| | - Monika Kirsch
- 2 Department of Anesthesiology, University Hospital of Basel, Switzerland
| | - Kris Denhaerynck
- 3 Institute of Nursing Science, University of Basel, Switzerland
| | | | - Remon Helmy
- 3 Institute of Nursing Science, University of Basel, Switzerland
| | - Cynthia L Russell
- 5 School of Nursing and Health Studies, University of Missouri-Kansas City, USA
| | - Lut Berben
- 3 Institute of Nursing Science, University of Basel, Switzerland
| | - Sabina De Geest
- 3 Institute of Nursing Science, University of Basel, Switzerland.,4 Academic Centre for Nursing and Midwifery, KU Leuven, Belgium
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Villeneuve C, Woillard JB, Knoop C, Essig M, Etienne I, Epailly E, Pison C, Debette-Gratien M, Marquet P, Monchaud C. Evaluation of Experiences with Immunosuppressive Drugs in Transplantation: Validation of the MESI Scale in French. Pharmaceut Med 2017. [DOI: 10.1007/s40290-017-0207-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Short- and Long-term Outcomes of De Novo Liver Transplant Patients Treated With Once-Daily Prolonged-Release Tacrolimus. Transplant Direct 2017; 3:e207. [PMID: 28894794 PMCID: PMC5585423 DOI: 10.1097/txd.0000000000000722] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/08/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Tacrolimus is the key immunosuppressive drug for liver transplantation. Once-daily prolonged-release tacrolimus (TAC-PR) exhibits good drug adherence but has difficulty controlling the trough level in the early phase of liver transplantation. The aim of this study was to compare the feasibility and efficacy of immediately starting oral TAC-PR versus traditional twice-daily tacrolimus (TAC-BID) in de novo liver transplantation recipients. METHODS The study included 28 patients treated with conventional TAC-BID and 60 patients treated with TAC-PR (median follow-up 70.5 months). Short-term and long-term outcomes were compared. RESULTS Patient characteristics were similar except for the incidence of hepatocellular carcinoma and type of graft. Dose adjustment was more frequently required for TAC-PR than TAC-BID (73.3% vs 42.9%, P = 0.006), but trough levels of TAC during the first 3 months after liver transplantation were controlled well in both groups. The rate of acute cellular rejection and long-term renal function were similar in both groups. In both groups, renal function worsened during the first 6 months after transplantation and remained stable until the end of the follow-up period. The 1-year, 3-year, and 5-year survival rates were 96.4%, 85.7%, and 85.7% for TAC-BID and 96.7%, 94.8%, and 94.8% for TAC-PR, respectively. The overall survival curve for TAC-PR was not inferior to that of TAC-BID. CONCLUSIONS The TAC-PR protocol was feasible and effective with strict adjustment.
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Nevins TE, Nickerson PW, Dew MA. Understanding Medication Nonadherence after Kidney Transplant. J Am Soc Nephrol 2017; 28:2290-2301. [PMID: 28630231 PMCID: PMC5533244 DOI: 10.1681/asn.2017020216] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Alloimmunity remains a barrier to long-term graft survival that necessitates lifelong immunosuppressive therapy after renal transplant. Medication nonadherence has been increasingly recognized as a major impediment to achieving effective immunosuppression. Electronic medication monitoring further reveals that nonadherence manifests early after transplant, although the effect is delayed. The etiology of nonadherence is multifactorial, with the strongest risk factors including past nonadherence and being an adolescent or young adult. Other risk factors with smaller but consistently important effects include minority race/ethnicity, poor social supports, and poor perceived health. In children, risk factors related to parental and child psychologic and behavioral functioning and parental distress and burden are also important. Qualitative systematic reviews highlight the need to tailor interventions to each transplant recipient's unique needs, motivations, and barriers rather than offer a one size fits all approach. To date, relatively few interventions have been studied, and most studies conducted were underpowered to allow definitive conclusions. If the kidney transplant community's goal of "one transplant for life" is to become a reality, then solutions for medication nonadherence must be found and implemented.
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Affiliation(s)
- Thomas E. Nevins
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Peter W. Nickerson
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; and
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania
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Leven EA, Annunziato R, Helcer J, Lieber SR, Knight CS, Wlodarkiewicz C, Soriano RP, Florman SS, Schiano TD, Shemesh E. Medication adherence and rejection rates in older vs younger adult liver transplant recipients. Clin Transplant 2017; 31. [PMID: 28370346 DOI: 10.1111/ctr.12981] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2017] [Indexed: 12/31/2022]
Abstract
A growing number of older adults are undergoing liver transplantation (LT) in the United States. In some settings, it is thought that adherence declines with age. This retrospective study examined adherence and clinical outcomes in older vs younger adult LT recipients. Medical records of adult LT recipients from 2009 to 2012 from a single urban center were reviewed. The medication level variability index (MLVI) was the predefined primary outcome, with nonadherence defined as MLVI >2.5. The secondary outcome was incidence of rejection. Outcomes were evaluated starting 1 year post-LT until 2015. A total of 42 of 248 patients were ≥65 at transplant. Older adults had significantly better adherence than younger ones (65%≥65 were adherent vs 42% younger adults; chi-square two-tailed P=.02). Survival analyses of rejection between age groups censored by time since transplant showed no difference among the four age groups (χ2 =0.84, P=.84). Older age was not found to be a risk factor for reduced adherence or graft rejection in patients surviving at least 1 year post-LT.
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Affiliation(s)
- Emily A Leven
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Annunziato
- Departments of Pediatrics and Psychiatry, Icahn School of Medicine at Mount Sinai, Fordham University, New York, NY, USA
| | - Jacqueline Helcer
- Departments of Pediatrics and Psychiatry, Icahn School of Medicine at Mount Sinai, Fordham University, New York, NY, USA
| | - Sarah R Lieber
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher S Knight
- Departments of Pediatrics and Psychiatry, Icahn School of Medicine at Mount Sinai, Fordham University, New York, NY, USA
| | | | - Rainier P Soriano
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sander S Florman
- Recanati Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Thomas D Schiano
- Intestinal Transplant Program, Recanati Miller Transplant Institute, Mount Sinai Hospital, New York, NY, USA
| | - Eyal Shemesh
- Division of Developmental Behavioral Pediatrics, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients: A Guidance Report and Clinical Checklist by the Consensus on Managing Modifiable Risk in Transplantation (COMMIT) Group. Transplantation 2017; 101:S1-S56. [PMID: 28328734 DOI: 10.1097/tp.0000000000001651] [Citation(s) in RCA: 181] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Short-term patient and graft outcomes continue to improve after kidney and liver transplantation, with 1-year survival rates over 80%; however, improving longer-term outcomes remains a challenge. Improving the function of grafts and health of recipients would not only enhance quality and length of life, but would also reduce the need for retransplantation, and thus increase the number of organs available for transplant. The clinical transplant community needs to identify and manage those patient modifiable factors, to decrease the risk of graft failure, and improve longer-term outcomes.COMMIT was formed in 2015 and is composed of 20 leading kidney and liver transplant specialists from 9 countries across Europe. The group's remit is to provide expert guidance for the long-term management of kidney and liver transplant patients, with the aim of improving outcomes by minimizing modifiable risks associated with poor graft and patient survival posttransplant.The objective of this supplement is to provide specific, practical recommendations, through the discussion of current evidence and best practice, for the management of modifiable risks in those kidney and liver transplant patients who have survived the first postoperative year. In addition, the provision of a checklist increases the clinical utility and accessibility of these recommendations, by offering a systematic and efficient way to implement screening and monitoring of modifiable risks in the clinical setting.
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Hu L, Lingler JH, Sereika SM, Burke LE, Malchano DK, DeVito Dabbs A, Dew MA. Nonadherence to the medical regimen after lung transplantation: A systematic review. Heart Lung 2017; 46:178-186. [DOI: 10.1016/j.hrtlng.2017.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 01/09/2017] [Accepted: 01/09/2017] [Indexed: 01/09/2023]
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Rosenberger EM, DeVito Dabbs AJ, DiMartini AF, Landsittel DP, Pilewski JM, Dew MA. Long-Term Follow-up of a Randomized Controlled Trial Evaluating a Mobile Health Intervention for Self-Management in Lung Transplant Recipients. Am J Transplant 2017; 17:1286-1293. [PMID: 27664940 PMCID: PMC5365382 DOI: 10.1111/ajt.14062] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/26/2016] [Accepted: 09/11/2016] [Indexed: 01/25/2023]
Abstract
Mobile health interventions may help transplant recipients follow their complex medical regimens. Pocket Personal Assistant for Tracking Health (Pocket PATH) is one such intervention tailored for lung transplant recipients. A randomized controlled trial showed Pocket PATH's superiority to usual care for promoting the self-management behaviors of adherence, self-monitoring and communication with clinicians during posttransplant year 1. Its long-term impact was unknown. In this study, we examined associations between Pocket PATH exposure during year 1 and longer term clinical outcomes-mortality and bronchiolitis obliterans syndrome (BOS)-among 182 recipients who survived the original trial. Cox regression assessed whether (a) original group assignment and (b) performance of self-management behaviors during year 1 predicted time to outcomes. Median follow-up was 5.7 years after transplant (range 4.2-7.2 years). Pocket PATH exposure had no direct effect on outcomes (p-values >0.05). Self-monitoring was associated with reduced mortality risk (hazard ratio [HR] 0.45; 95% confidence interval [CI] 0.22-0.91; p = 0.027), and reporting abnormal health indicators to clinicians was associated with reduced risks of mortality (HR 0.15; 95% CI 0.04-0.65; p = 0.011) and BOS (HR 0.27; 95% CI 0.08-0.86; p = 0.026), regardless of intervention group assignment. Although Pocket PATH did not have a direct impact on long-term outcomes, early improvements in self-management facilitated by Pocket PATH may be associated with long-term clinical benefit.
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Affiliation(s)
- Emily M. Rosenberger
- Department of Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Annette J. DeVito Dabbs
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA
| | - Andrea F. DiMartini
- Departments of Psychiatry and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Douglas P. Landsittel
- Departments of Medicine, Biostatistics, and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Joseph M. Pilewski
- Departments of Medicine, Pediatrics, and Cell Biology and Physiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology, Biostatistics, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA
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Brocks Y, Zittermann A, Grisse D, Schmid-Ott G, Stock-Gießendanner S, Schulz U, Brakhage J, Benkler A, Gummert J, Tigges-Limmer K. Adherence of Heart Transplant Recipients to Prescribed Medication and Recommended Lifestyle Habits. Prog Transplant 2017; 27:160-166. [PMID: 28617170 DOI: 10.1177/1526924817699959] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Nonadherence may cause severe health problems in heart transplant (HTx) recipients. RESEARCH QUESTIONS The present study aimed to investigate adherence to prescribed medication and recommended lifestyle habits in post-HTx patients and to assess associations between adherence, quality of life (QOL), and psychological well-being. DESIGN A questionnaire package was sent to all HTx patients from our clinic (n = 858) to answer questions anonymously on medication adherence, dietary recommendations (avoidance of raw animal products and ice cream), pet keeping (risk of zoonosis), anxiety and depression, QOL, and posttraumatic stress disorders. RESULTS Of the contacted patients, 524 (61%) responded and 505 fulfilled the inclusion criteria (age ≥18 years and ability to understand German). Of the study participants, 72.4% reported taking their medications very correctly, 72.2% stated consuming alcohol less often than once a week, 58.3% performed physical exercise at least once a week, one-third reported eating nonrecommended foods, 22.1% stated pet keeping, and 4.3% reported smoking. Adherence to prescribed medication was positively associated with age ( P < .001) and mental QOL ( P = .015) but was unrelated to eating nonrecommended foods ( P > .05). Depressiveness correlated inversely with physical QOL ( r = -0.232; P < .01) and mental QOL ( r = -0.411; P < .01). Stress disorders and minor stressful events were reported by 7.8% and 46.6%, respectively. Stress disorders correlated inversely with mental QOL ( r = -0.282; P < .01) and physical QOL ( r = -0.422; P < .01). DISCUSSION Many HTx patients adhere to prescribed medications and health advice. Nevertheless, nonadherence is a problem, especially in younger HTx patients, indicating the need for a nonadherence crisis intervention program for long-term HTx patients.
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Affiliation(s)
- Y Brocks
- 1 Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - A Zittermann
- 1 Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - D Grisse
- 1 Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | | | | | - U Schulz
- 1 Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - J Brakhage
- 1 Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | | | - J Gummert
- 1 Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Katharina Tigges-Limmer
- 1 Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
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Maier M, Takano T, Sapir-Pichhadze R. Changing Paradigms in the Management of Rejection in Kidney Transplantation: Evolving From Protocol-Based Care to the Era of P4 Medicine. Can J Kidney Health Dis 2017; 4:2054358116688227. [PMID: 28270929 PMCID: PMC5308536 DOI: 10.1177/2054358116688227] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/17/2016] [Indexed: 12/30/2022] Open
Abstract
PURPOSE OF REVIEW P4 medicine denotes an evolving field of medicine encompassing predictive, preventive, personalized, and participatory medicine. Using the example of kidney allograft rejection because of donor-recipient incompatibility in human leukocyte antigens, this review outlines P4 medicine's relevance to the various stages of the kidney transplant cycle. SOURCES OF INFORMATION A search for English articles was conducted in Medline via OvidSP (up to August 18, 2016) using a combination of subject headings (MeSH) and free text in titles, abstracts, and author keywords for the concepts kidney transplantation and P4 medicine. The electronic database search was expanded further on particular subject headings. FINDINGS Available histocompatibility methods exemplify current applications of the predictive and preventive domains of P4 medicine in kidney transplant recipients' care. Pharmacogenomics are discussed as means to facilitate personalized immunosuppression regimens and promotion of active patient participation as a means to improve adherence. LIMITATIONS For simplicity, this review focuses on rejection. P4 medicine, however, should more broadly address health concerns in kidney transplant recipients, including competing outcomes such as infections, malignancies, and cardiovascular disease. This review highlights how biomarkers to evaluate these competing outcomes warrant validation and standardization prior to their incorporation into clinical practice. IMPLICATIONS Consideration of all 4 domains of the P4 medicine framework when caring for and/or studying kidney transplant recipients has the potential of increasing therapeutic efficiency, minimizing adverse effects, decreasing health care costs, and maximizing wellness. Technologies to gauge immune competency, immunosuppression requirements, and early/reversible immune-mediated injuries are required to optimize kidney transplant care.
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Affiliation(s)
- Mirela Maier
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Metabolic Disorders and Complications, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Tomoko Takano
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Metabolic Disorders and Complications, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Ruth Sapir-Pichhadze
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Metabolic Disorders and Complications, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- Multi-Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, McGill University Health Centre, Montreal, Quebec, Canada
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78
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Dobbels F, De Bleser L, Berben L, Kristanto P, Dupont L, Nevens F, Vanhaecke J, Verleden G, De Geest S. Efficacy of a medication adherence enhancing intervention in transplantation: The MAESTRO-Tx trial. J Heart Lung Transplant 2017; 36:499-508. [PMID: 28162931 DOI: 10.1016/j.healun.2017.01.007] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 12/22/2016] [Accepted: 01/04/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Well-designed randomized controlled trials (RCTs) testing efficacy of post-transplant medication adherence enhancing interventions and clinical outcomes are scarce. METHODS This randomized controlled trial enrolled adult heart, liver, and lung transplant recipients who were >1 year post-transplant and on tacrolimus twice daily (convenience sample) (visit 1). After a 3-month run-in period, patients were randomly assigned 1:1 to intervention group (IG) or control group (CG) (visit 2), followed by a 6-month intervention (visits 2-4) and a 6-month adherence follow-up period (visit 5). All patients used electronic monitoring for 15 months for adherence measurement, generating a daily binary adherence score per patient. Post-intervention 5-year clinical event-free survival (mortality or retransplantation) was evaluated. The IG received staged multicomponent tailored behavioral interventions (visits 2-4) building on social cognitive theory and trans-theoretical model (e.g., electronic monitoring feedback, motivational interviewing). The CG received usual care and attended visits 1-5 only. Intention-to-treat analysis used generalized estimating equation modeling and Kaplan-Meier survival analysis. RESULTS Of 247 patients, 205 were randomly assigned (103 IG, 102 CG). At baseline, average daily proportions of patients with correct dosing (82.6% IG, 78.4% CG) and timing adherence (75.8% IG, 72.2% CG) were comparable. The IG had a 16% higher dosing adherence post-intervention (95.1% IG, 79.1% CG; p < 0.001), resulting in odds of adherence being 5 times higher in the IG than in the CG (odds ratio 5.17, 95% confidence interval 2.86-9.38). This effect was sustained at end of follow-up (similar results for timing adherence). In the IG, 5-year clinical event-free survival was 82.5% vs 72.5% in the CG (p = 0.18). CONCLUSION Our intervention was efficacious in improving adherence and sustainable. Further research should investigate clinical impact, cost-effectiveness, and scalability.
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Affiliation(s)
- Fabienne Dobbels
- Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Institute of Nursing Science, University of Basel, Basel, Switzerland.
| | - Leentje De Bleser
- Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Lut Berben
- Institute of Nursing Science, University of Basel, Basel, Switzerland
| | | | - Lieven Dupont
- Lung Transplant Program, University Hospitals of Leuven, Leuven, Belgium
| | - Frederik Nevens
- Liver Transplant Program, University Hospitals of Leuven, Leuven, Belgium
| | - Johan Vanhaecke
- Heart Transplant Program, University Hospitals of Leuven, Leuven, Belgium
| | - Geert Verleden
- Lung Transplant Program, University Hospitals of Leuven, Leuven, Belgium
| | - Sabina De Geest
- Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Institute of Nursing Science, University of Basel, Basel, Switzerland
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79
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Michaud L, Ludwig G, Berney S, Rodrigues S, Niquille A, Santschi V, Favre AS, Lange AC, Michels AA, Vrijens B, Bugnon O, Pilon N, Pascual M, Venetz JP, Stiefel F, Schneider MP. Immunosuppressive therapy after solid-organ transplantation: does the INTERMED identify patients at risk of poor adherence? Pharm Pract (Granada) 2016; 14:822. [PMID: 28042353 PMCID: PMC5184375 DOI: 10.18549/pharmpract.2016.04.822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/26/2016] [Indexed: 12/23/2022] Open
Abstract
Background: Lack of adherence to medication is a trigger of graft rejection in solid-organ transplant (SOT) recipients. Objective: This exploratory study aimed to assess whether a biopsychosocial evaluation using the INTERMED instrument before transplantation could identify SOT recipients at risk of suboptimal post-transplantation adherence to immunosuppressant drugs. We hypothesized that complex patients (INTERMED>20) might have lower medication adherence than noncomplex patients (INTERMED≤20). Methods: Each patient eligible for transplantation at the University Hospital of Lausanne, Switzerland, has to undergo a pre-transplantation psychiatric evaluation. In this context the patient was asked to participate in our study. The INTERMED was completed pre-transplantation, and adherence to immunosuppressive medication was monitored post-transplantation by electronic monitors for 12 months. The main outcome measure was the implementation and persistence to two calcineurin inhibitors, cyclosporine and tacrolimus, according to the dichotomized INTERMED score (>20 or ≤20). Results: Among the 50 SOT recipients who completed the INTERMED, 32 entered the study. The complex (N=11) and noncomplex patients (N=21) were similar in terms of age, sex and transplanted organ. Implementation was 94.2% in noncomplex patients versus 87.8% in complex patients (non-significant p-value). Five patients were lost to follow-up: one was non-persistent, and four refused electronic monitoring. Of the four patients who refused monitoring, two were complex and withdrew early, and two were noncomplex and withdrew later in the study. Conclusion: Patients identified as complex pre-transplant by the INTERMED tended to deviate from their immunosuppressant regimen, but the findings were not statistically significant. Larger studies are needed to evaluate this association further, as well as the appropriateness of using a nonspecific biopsychosocial instrument such as INTERMED in highly morbid patients who have complex social and psychological characteristics.
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Affiliation(s)
- Laurent Michaud
- Psychiatric Liaison Service, University Hospital of Lausanne (CHUV). Lausanne ( Switzerland ).
| | - Gundula Ludwig
- Psychiatric Liaison Service, University Hospital of Lausanne (CHUV). Lausanne ( Switzerland ).
| | - Sylvie Berney
- General Psychiatry Service, University Hospital of Lausanne (CHUV). Lausanne ( Switzerland ).
| | | | - Anne Niquille
- Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne . Lausanne ( Switzerland ).
| | - Valérie Santschi
- Professor, La Source School of Nursing Sciences, University of Applied Sciences Western Switzerland . Lausanne ( Switzerland ).
| | - Anne-Sophie Favre
- Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne . Lausanne ( Switzerland ).
| | | | - Annemieke A Michels
- Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne . Lausanne ( Switzerland ).
| | - Bernard Vrijens
- University of Liège , Belgium and Chief Science Officer, Westrock Healthcare. Visé ( Belgium ).
| | - Olivier Bugnon
- School of pharmaceutical sciences, University of Geneva, University of Lausanne , Switzerland and Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne. Lausanne ( Switzerland ).
| | - Nathalie Pilon
- Transplantation Centre, University Hospital of Lausanne (CHUV) . Lausanne ( Switzerland ).
| | - Manuel Pascual
- Transplantation Centre, University Hospital of Lausanne (CHUV) . Lausanne ( Switzerland ).
| | - Jean-Pierre Venetz
- Transplantation Centre, University Hospital of Lausanne (CHUV) . Lausanne ( Switzerland ).
| | - Friedrich Stiefel
- Psychiatric Liaison Service, University Hospital of Lausanne (CHUV). Lausanne ( Switzerland ).
| | - Marie-Paule Schneider
- Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne , Switzerland and Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne . Lausanne ( Switzerland ).
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80
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Reese PP, Bloom RD, Trofe-Clark J, Mussell A, Leidy D, Levsky S, Zhu J, Yang L, Wang W, Troxel A, Feldman HI, Volpp K. Automated Reminders and Physician Notification to Promote Immunosuppression Adherence Among Kidney Transplant Recipients: A Randomized Trial. Am J Kidney Dis 2016; 69:400-409. [PMID: 27940063 DOI: 10.1053/j.ajkd.2016.10.017] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 10/10/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Immunosuppression nonadherence increases the risk for kidney transplant loss after transplantation. Wireless-enabled pill bottles have created the opportunity to monitor medication adherence in real time. Reminders may help patients with poor memory or organization. Provision of adherence data to providers may motivate patients to improve adherence and help providers identify adherence barriers. STUDY DESIGN Randomized controlled trial. SETTING & PARTICIPANTS Kidney transplant recipients (n=120) at a single center. INTERVENTION Participants were provided wireless pill bottles to store tacrolimus and record bottle openings. Participants were randomly assigned 1:1:1 to adherence monitoring with customized reminders (including alarms, texts, telephone calls, and/or e-mails), monitoring with customized reminders plus provider notification (every 2 weeks, providers received notification if adherence decreased to <90% during that period), or wireless pill bottle use alone (control). OUTCOMES The main outcome was bottle-measured tacrolimus adherence during the last 90 days of the 180-day trial. A secondary outcome was tacrolimus whole-blood concentrations at routine clinical visits. MEASUREMENTS Adherence for the primary outcome was assessed via wireless pill bottle openings. RESULTS Mean participant age was 50 years; 60% were men, and 40% were black. Mean adherence was 78%, 88%, and 55% in the reminders, reminders-plus-notification, and control arms (P<0.001 for comparison of each intervention to control). Mean tacrolimus levels were not significantly different between groups. LIMITATIONS The study did not assess clinical end points. Participants and study coordinators were not blinded to intervention arm. CONCLUSIONS Provider notification and customized reminders appear promising in helping patients achieve better medication adherence, but these strategies require evaluation in trials powered to detect differences in clinical outcomes.
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Affiliation(s)
- Peter P Reese
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA.
| | - Roy D Bloom
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jennifer Trofe-Clark
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Adam Mussell
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Daniel Leidy
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Simona Levsky
- School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA
| | - Jingsan Zhu
- Leonard Davis Institute Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA
| | - Lin Yang
- Leonard Davis Institute Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA
| | - Wenli Wang
- Leonard Davis Institute Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA
| | - Andrea Troxel
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA
| | - Harold I Feldman
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Kevin Volpp
- Leonard Davis Institute Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA; Department of Medicine and Medical Ethics and Health Policy, Perelman School of Medicine, Philadelphia, PA; Department of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia, PA; Center for Health Equity Research and Promotion, Cresencz Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
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81
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Mauthner O, Claes V, Walston J, Engberg S, Binet I, Dickenmann M, Golshayan D, Hadaya K, Huynh-Do U, Calciolari S, De Geest S. ExplorinG frailty and mild cognitive impairmEnt in kidney tRansplantation to predict biomedicAl, psychosocial and health cost outcomeS (GERAS): protocol of a nationwide prospective cohort study. J Adv Nurs 2016; 73:716-734. [DOI: 10.1111/jan.13179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2016] [Indexed: 01/25/2023]
Affiliation(s)
- Oliver Mauthner
- Institute of Nursing Science; University of Basel; Switzerland
| | - Veerle Claes
- Institute of Nursing Science; University of Basel; Switzerland
| | - Jeremy Walston
- Center on Aging and Health; Johns Hopkins University; Baltimore Maryland USA
| | - Sandra Engberg
- Institute of Nursing Science; University of Basel; Switzerland
- School of Nursing; University of Pittsburgh; Pennsylvania USA
| | - Isabelle Binet
- Clinic of Nephrology and Transplantation Medicine; Cantonal Hospital St Gallen; Switzerland
| | - Michael Dickenmann
- Department for Transplantation-Immunology and Nephrology; University Hospital Basel; Switzerland
| | - Déla Golshayan
- Transplantation Centre and Transplantation Immunopathology Laboratory; University Hospital Lausanne; Switzerland
| | - Karine Hadaya
- Department of Nephrology; University Hospital Geneva; Switzerland
| | - Uyen Huynh-Do
- University Clinic for Nephrology, Hypertension and Clinical Pharmacology; University Hospital Bern; Switzerland
| | | | - Sabina De Geest
- Institute of Nursing Science; University of Basel; Switzerland
- Academic Center for Nursing and Midwifery; KU Leuven; Belgium
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82
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Weng LC, Yang YC, Huang HL, Chiang YJ, Tsai YH. Factors that determine self-reported immunosuppressant adherence in kidney transplant recipients: a correlational study. J Adv Nurs 2016; 73:228-239. [DOI: 10.1111/jan.13106] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Li-Chueh Weng
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
- Department of General Surgery; Chang Gung Medical Foundation-Linkuo; Taoyuan Taiwan
| | - Ya-Chen Yang
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Hsiu-Li Huang
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
- Department of Neurology; Chang Gung Medical Foundation-Linkuo; Taoyuan; Taiwan
| | - Yang-Jen Chiang
- Transplantation Center and Urology Surgery; Chang Gung Medical Foundation-Linkuo Medical Center; Taoyuan Taiwan
| | - Yu-Hsia Tsai
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
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83
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Abstract
BACKGROUND Whether or not patients follow the advice given by their healthcare professional is commonly referred to as adherence. In the case of kidney transplantation, transplant recipients need to take immunosuppressive drugs on a regular basis to prevent rejection of their transplant. However, medication adherence can be problematic for many patients. OBJECTIVES This critical appraisal of evidence aimed to gain insights into factors contributing to adherence and non-adherence in recipients of kidney transplants, and to explore patients' perceptions regarding adherence to immunosuppression. METHODS A comprehensive literature search was performed using Medline, PsycInfo, the Joanna Briggs Institute, CINAHL and the Cochrane Library. Included were primary research studies or reviews of primary research, independent of their research paradigms, on adult kidney or kidney/pancreas transplant recipients published in English or German. Children or adolescents were not considered. No time-frame was applied RESULTS: Fifty-two papers were included in the review. All extracted findings of included papers were organised according to the five factors influencing medication-taking behaviour as defined by the World Health Organisation: social and economic factors; therapy-related factors; patient-related factors; condition-related factors; healthcare team and system-related factors. CONCLUSION Reasons for non-adherence after kidney transplantations are diverse. Attention is attracted by the fact that potentially modifiable factors such as social support, experiences on dialysis, side effects, features of the treatment regimen, intentions and beliefs, forgetfulness and mental health issues play a greater role than other factors in the development of medication non-adherence. Factors not related to patient characteristics seem to be under researched.
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Affiliation(s)
- Anne Rebafka
- Department of Internal Medicine, University Medical Centre Freiburg, PDL-Buero Medizin, Freiburg, Germany
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84
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Beckmann S, Künzler-Heule P, Biotti B, Spirig R. Mastering Together the Highs and Lows. Prog Transplant 2016; 26:215-23. [DOI: 10.1177/1526924816654769] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Context: Self-management in chronic illness involves complex medical, role-related, and emotional tasks. Still, while self-management support of patients and their families has become a cornerstone of chronic illness care, information is limited as to how liver transplant (LTx) patients and close caregivers perceive self-management before and after transplantation. Objective: To explore self-management tasks in view of medical, role-related, and emotional tasks in LTx candidates and recipients and their respective close caregivers. Design and Participants: For this qualitative study, focus group interviews were conducted and analyzed using knowledge mapping according to the 3 above-noted self-management categories. German-speaking adults who were wait-listed for or had received LTx and who were being treated in University Hospital Zurich or who were close caregivers to such patients were eligible for participation. As patients’ data were closely related to those of the caregivers, the 2 groups’ data sets were merged during the final development of themes. Results: Thirty participants comprised 7 focus groups. The main theme was “The current state of health determines the daily rhythm.” The essence of how patients and caregivers described their self-management tasks is compiled in “Mastering together the highs and lows” which comprises 3 core themes: mastering medical management, managing roles together, and managing the highs and lows of emotion. Conclusion: Patients and close caregivers prioritized self-management tasks as follows: first medical, then role-related, and finally emotional management. Over the course of LTx, health-care professionals should acknowledge this ranking while providing individualized support to both patients and caregivers.
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Affiliation(s)
- Sonja Beckmann
- Department of Abdomen and Metabolism, University Hospital Zurich, Zurich, Switzerland
- Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Patrizia Künzler-Heule
- Department of Gastroenterology and Hepatology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Beatrice Biotti
- Department of Abdomen and Metabolism, University Hospital Zurich, Zurich, Switzerland
| | - Rebecca Spirig
- Institute of Nursing Science, University of Basel, Basel, Switzerland
- Department of Nursing and MTTB, University Hospital Zurich, Zurich, Switzerland
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85
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Abstract
BACKGROUND Graft failure risk is highest during emerging adulthood (17-24 years) in kidney and heart transplant. It is unknown whether a similar association exists in liver transplant recipients. METHODS We sought to estimate the relative hazards of graft failure at different current ages, compared with those aged 21 to 24 years. We evaluated 17 181 patients recorded in the Scientific Registry of Transplant Recipients who received a first isolated liver transplant at 40 years or younger (1988-2013) and had 6 months or longer of graft function. We used time-dependent Cox models to estimate the association between current age and failure risk, defined as retransplant or death after graft failure; observation was censored at death with graft function. RESULTS There were 2540 failures. Absolute graft failure rates were highest in ages 25 to 29 years (3.0/100 person-years). Compared with individuals with the same time since transplantation, those aged 21 to 24 years had significantly higher failure rates than those younger than 17 years and older than 34 years; hazards did not differ for those aged 25 to 29 years (1.03 [0.86, 1.24]) and were lower, but not significantly, for those aged 17 to 20 years (hazards ratio, 0.83; 95% confidence interval, 0.68-1.01) and ages 30 to 34 years (hazards ratio, 0.84; 95% confidence interval, 0.70-1.01). CONCLUSIONS Among young first isolated liver transplant recipients, graft failure risks are highest in the period from 21 to 29 years of age.
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86
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Doyle IC, Maldonado AQ, Heldenbrand S, Tichy EM, Trofe-Clark J. Nonadherence to therapy after adult solid organ transplantation: A focus on risks and mitigation strategies. Am J Health Syst Pharm 2016; 73:909-20. [PMID: 27189855 DOI: 10.2146/ajhp150650] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Ian C Doyle
- School of Pharmacy, Pacific University, Hillsboro, OR.
| | | | - Seth Heldenbrand
- Office of Experiential Education, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Eric M Tichy
- Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT
| | - Jennifer Trofe-Clark
- Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, PARenal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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87
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Patients’ Early Post-Operative Experiences with Lung Transplantation: A Longitudinal Qualitative Study. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 9:547-557. [DOI: 10.1007/s40271-016-0174-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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88
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The Influence of Immunosuppressive Agents on the Risk of De Novo Donor-Specific HLA Antibody Production in Solid Organ Transplant Recipients. Transplantation 2016; 100:39-53. [PMID: 26680372 PMCID: PMC4683034 DOI: 10.1097/tp.0000000000000869] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Production of de novo donor-specific antibodies (dnDSA) is a major risk factor for acute and chronic antibody-mediated rejection and graft loss after all solid organ transplantation. In this article, we review the data available on the risk of individual immunosuppressive agents and their ability to prevent dnDSA production. Induction therapy with rabbit antithymocyte globulin may achieve a short-term decrease in dnDSA production in moderately sensitized patients. Rituximab induction may be beneficial in sensitized patients, and in abrogating rebound antibody response in patients undergoing desensitization or treatment for antibody-mediated rejection. Use of bortezomib for induction therapy in at-risk patients is of interest, but the benefits are unproven. In maintenance regimens, nonadherent and previously sensitized patients are not suitable for aggressive weaning protocols, particularly early calcineurin inhibitor withdrawal without lymphocyte-depleting induction. Early conversion to mammalian target of rapamycin inhibitor monotherapy has been reported to increase the risk of dnDSA formation, but a combination of mammalian target of rapamycin inhibitor and reduced-exposure calcineurin inhibitor does not appear to alter the risk. Early steroid therapy withdrawal in standard-risk patients after induction has no known dnDSA penalty. The available data do not demonstrate a consistent effect of mycophenolic acid on dnDSA production. Risk minimization for dnDSA requires monitoring of adherence, appropriate risk stratification, risk-based immunosuppression intensity, and prospective DSA surveillance.
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89
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Recommendations on How to Improve Medication Adherence Studies in the Field of Transplantation. Transplantation 2015; 100:12-3. [PMID: 26588005 DOI: 10.1097/tp.0000000000000972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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90
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Abstract
PURPOSE OF REVIEW Psychiatrists and other mental health professionals typically assist with evaluating and treating psychiatric and behavioral issues in transplant candidates, recipients, and living organ donors. In this review recent findings on specific psychiatric issues in adult solid organ transplant candidates and recipients, as well as living donors are discussed as well as their relevance to clinical practice. RECENT FINDINGS Patients with complex mental health and addiction histories can have outcomes similar to patients without these disorders but may require specialized pretransplant preparation or posttransplant interventions to optimize their outcomes. Specific attention to the preparation and wellbeing of living donors is needed. SUMMARY As transplant programmes increasingly consider patients with complex mental health histories, psychiatrists, and mental health professionals evaluating and treating these patients need to consider plans for early identification and treatment. Psychiatric care provided across the preoperative to postoperative periods will best address the longitudinal care needs of patients with mental health disorders. Abstinence from substances and complete adherence to medical directives provides the best chance for optimal outcomes. Treatment of depression may improve transplant outcomes. Research is needed to identify effective interventions and the best strategies to engage patients to improve adherence. VIDEO ABSTRACT http://links.lww.com/YCO/A30.
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91
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Abstract
PURPOSE OF REVIEW Nonadherence is a major problem in heart transplantation (htx) and a challenge for clinical practice and research. In heart transplant recipients, nonadherence could cause chronic rejection of the transplanted heart followed by difficult clinical course and/or death of the patient. RECENT FINDINGS Main topics are the relationship between psychological aspects and adherence, risk factors and prediction of nonadherence, strategies for improving adherence like single-dose immunosuppressant therapy and follow-up studies. SUMMARY There is a lack of behavioral intervention studies. So-called targeted interventions should be defined for clinical practice and research with randomized controlled studies.
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92
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Berger C, Bochud PY, Boggian K, Cusini A, Egli A, Garzoni C, Hirsch HH, Hoffmann M, Khanna N, Manuel O, Meylan P, Nadal D, van Delden C, Weisser M, Mueller NJ. The swiss transplant cohort study: lessons from the first 6 years. Curr Infect Dis Rep 2015; 17:486. [PMID: 25916997 DOI: 10.1007/s11908-015-0486-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Prospective cohort studies significantly contribute to answering specific research questions in a defined population. Since 2008, the Swiss Transplant Cohort Study (STCS) systematically enrolled >95 % of all transplant recipients in Switzerland, collecting predefined data at determined time points. Designed as an open cohort, the STCS has included >3900 patients to date, with a median follow-up of 2.96 years (IQR 1.44-4.73). This review highlights some relevant findings in the field of transplant-associated infections gained by the STCS so far. Three key general aspects have crystallized: (i) Well-run cohort studies are a powerful tool to conduct genetic studies, which are crucially dependent on a meticulously described phenotype. (ii) Long-term real-life observations are adding a distinct layer of information that cannot be obtained during randomized studies. (iii) The systemic collection of data, close interdisciplinary collaboration, and continuous analysis of some key outcome data such as infectious diseases endpoints can improve patient care.
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Affiliation(s)
- Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology and Children's Research Center, University Children's Hospital of Zürich, Zürich, Switzerland
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Changing definitions of successful outcomes in pediatric liver transplantation. Curr Opin Organ Transplant 2014; 19:480-5. [DOI: 10.1097/mot.0000000000000116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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