Determinants of Medication Adherence in Liver Transplant Recipients

Mayank Jain; Jayanthi Venkataraman; Mettu S Reddy; Mohamed Rela

doi:10.1016/j.jceh.2019.03.003

Determinants of Medication Adherence in Liver Transplant Recipients

J Clin Exp Hepatol. 2019 Nov-Dec;9(6):676-683. doi: 10.1016/j.jceh.2019.03.003. Epub 2019 Mar 19.

Authors

Mayank Jain¹, Jayanthi Venkataraman¹, Mettu S Reddy¹, Mohamed Rela¹

Affiliation

¹ Institute of Liver Disease and Transplantation, Gleneagles Global Health City, Chennai 100, India.

Abstract

Background: The aim of this study was to study the determinants of nonadherence to immunosuppressant drugs in liver transplant (LT) recipients using personalised interview and questionnaire methods.

Methods: The study was conducted on adult LT recipients (deceased donor liver transplant [DDLT] and living donor liver transplant [LDLT]) from the Indian subcontinent, at post-LT clinic visit between July and December 2016. Recipient details included baseline demography, comorbidity, psychological status, details of addiction, indication and type of transplant. Details on financial support for transplantation, admissions for rejection, infection and posttransplant complications were obtained from the hospital records. An adherence questionnaire was completed by direct interview and using a questionnaire.

Results: Sixty-seven LT recipients (56 males, median age 48.17 years) constituted the study group. Overall, 11 patients (16.47%) were nonadherent to treatment. LDLT recipients were more adherent than DDLT recipients. Nonadherent recipients were believers in alternative systems of medicine. Medication-related factors such as improper dosing, meagre drug knowledge difficulty in remembering drug dose and timings and economic constraints in continuing medical treatment were statistically significant in nonadherent recipients. Although variation in the tacrolimus levels were significantly more common in the nonadherent group, acute cellular rejection and infection were not statistically different.

Conclusions: The prevalence of nonadherence was 16.5%. Determinants of nonadherence were DDLT, belief in alternative medications, high regimen complexity, poor knowledge about medications and cost issues with long-term medications.

Keywords: ACR, Acute cellular Rejection; CAM, Complementary and Alternative Medicine; DDLT, Deceased Donor Liver Transplant; India; LDLT, Living Donor Liver Transplant; LT, liver transplantation; adherence; liver; transplant.