Perceived barriers to medication adherence remain stable following solid organ transplantation. (12th February 2019)

• Record Type: Journal Article
• Authors: Danziger‐Isakov, Lara; Frazier, Thomas W.; Worley, Sarah; Williams, Nikki; Shellmer, Diana; Dharnidharka, Vikas R.; Gupta, Nitika A.; Ikle, David; Shemesh, Eyal; Sweet, Stuart C.
• Other Names: Harmon William investigator.; Spaneas Leslie investigator.; Thakkallapalli Erin Leone investigator.; Garrigan Kate investigator.; O'Brien Molly investigator.; Dubert Beatrice investigator.; Valcourt‐Dexter Stephanie investigator.; Addonizio Linda investigator.; Zuckerman Warren investigator.; Rodriguez Rose investigator.; Goldfarb Samuel investigator.; Kim Rosa investigator.; Nguyen Sara investigator.; Webber Steven investigator.; Feingold Brian investigator.; West Shawn investigator.; Luce Jane investigator.; McDonald Ruth investigator.; Smith Jodi investigator.; Johnson Robert investigator.; Goldfarb Johanna investigator.; Lach Donna investigator.; Amaral Sandra investigator.; Weissenborn Verena investigator.; Dodd Rachel investigator.; Schwartz Gail investigator.; Haughton Monica investigator.; Arechiga Lu investigator.; Conrad Carol investigator.; Orbe Emily investigator.; Mistry Nirvi investigator.; Merkel Elisabeth investigator.; Bhamre Suvarna investigator.; Tsai Eileen investigator.; Holloway Maggie investigator.; White Claire investigator.; Hayes Don investigator.; Kirkby Stephen investigator.; Nance Ashley investigator.; Nicholson Kerri investigator.; Meyer Susan investigator.; Kurtz Tracie investigator.; Eisenbarger Colleen investigator.; Mallory George investigator.; Schecter Marc investigator.; Melicoff Tina investigator.; Bujan Janet investigator.; Sellers Charles investigator.; Schaap Nicoline investigator.; Ebenbichler Mea investigator.; Askenazi David investigator.; Feig Dan investigator.; Logue Amy investigator.; Clevenger Stephanie investigator.; Koralkar Rajesh investigator.; Keeling Susan investigator.; Lee Marsha investigator.; Lemp Stephanie investigator.; Chu Jenny investigator.; Laksshamanan Vino investigator.;
• Is Part Of: Pediatric transplantation. Volume 23:Number 3(2019)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2019-02-12
• Subjects: adherence -- pediatric -- solid organ transplant; Transplantation of organs, tissues, etc. in children -- Periodicals; 617.95408305
• DOI: 10.1111/petr.13361
• Languages: English
• ISSNs: 1397-3142

Abstract

Abstract: Perceived barriers to adherence have previously been investigated in SOT to identify plausible intervention targets to improve adherence and transplant outcomes. Fifteen centers in CTOTC enrolled patients longitudinally. Patients >8 years completed Adolescent Scale(AMBS) at two visits at least 6 months apart in the first 17 months post‐transplant while their guardians completed PMBS. Differences over time for pre‐identified AMBS/PMBS factors were analyzed. Perceived barrier reporting impact on subsequent TAC levels was assessed. A total of 123 patients or their guardians completed PMBS or AMBS. Twenty‐six were 6‐11 years and 97 were ≥12. The final cohort consisted of kidney (66%), lung (19%), liver (8%), and heart (7%) recipients. Unadjusted analysis showed no statistically significant change in reported barriers from visit 1 (median 2.6 months, range 1.2‐3.7 post‐transplant) to visit 2 (median 12, range 8.9‐16.5). Of 102 patients with TAC levels, 74 had a single level reported at both visits. The factor of "Disease frustration" was identified through the PMBS/AMBS questions about fatigue around medication and disease. Each point increase in "disease frustration" at visit 1 on the AMBS/PMBS doubled the odds of a lower‐than‐threshold TAC level at visit 2. No clear change in overall level of perceived barriers to medication adherence in the first year post‐transplant was seen in pediatric SOT. However, disease frustration early post‐transplant was associated with a single subtherapeutic TAC levels at 12 months. A brief screening measure may allow for early self‐identification of risk.