January 21, 2015
Complexity of Post Liver-Transplant Regimen Difficult for
Some Patients 

Philadelphia—Liver-transplant recipients may have trouble following their prescribed drug regimen, especially it involves a number of medications and they have low literacy.

That’s according to a new study published recently in the journal Liver Transplantation, which finds that nonadherence can lead to adverse clinical outcomes, such as organ rejection or graft loss.

Although improvements in surgical techniques and advances in immunosuppressive drug therapies have increased survival rates for those undergoing solid organ transplantation in the last 3 decades, the effectiveness of immunosuppressives might be hindered by multidrug regimens that require strict adherence over time, according to the report. The study, led by researchers from the Hospital of the University of Pennsylvania, note that nonadherence is responsible for nearly 50% of late acute rejections and 15% of graft losses in adults.

“This is the first study to investigate medication-taking behavior and evaluate regimen adherence and its clinical impact on liver transplant recipients,” explained lead author Marina Serper, MD. “It is important to understand how crucial self-care behaviors, such as following treatment plans, could lead to re-hospitalization, graft rejection, and infection if post-transplant regimens are not followed.”

Participants in the study were 105 patients who underwent liver transplantation between 2011 and 2012 at two transplant centers in Chicago and Atlanta. Most of the patients were middle-aged men, with 15% having limited literacy. The average number of medications used by the patients, meanwhile, was 11, with 39% of the group having had a change in medication within the last month.

Results indicate that participants understood, on average, 86% of their entire medication regimen, which translated to knowing 90% of their immunosuppressive drug indications, 73% of their transplant medications, and 85% of medications for chronic conditions.

For demonstration of proper adherence to the drug therapy regimen, the score was 78% for all medications, 66% for transplant immunosuppressive medications, 76% for transplant nonimmunosuppressives, and 84% for chronic disease medications.

Self-reported nonadherence to the therapy regimen was 14%, but tacrolimus levels indicated that number was more than double that, 32%.

“In multivariate analyses, lower income, less time since transplant, a higher number of medications, and limited literacy were inversely associated with treatment knowledge scores (all p<0.05), whereas limited literacy was associated with non-adherence by tacrolimus levels (p<0.05),” according to the article.

On the other hand, higher scores for treatment knowledge and demonstrated regimen use were independently associated with reduced post-transplant rehospitalization—15% and 13%, respectively, according to the study.

“By involving existing transplant center resources in cost-effective interventions that help patients properly manage their drug regimens, we could see an improvement in long term health of solid organ transplant recipients,” Serper concluded.

U.S. Pharmacist Social Connect