Medication Noncompliance and its Implications in Transplant Recipients
The transplant patient’s therapeutic regimen consists of a lifelong drug therapy, including immunosuppressive drugs, prophylactic antimicrobials and often medications for the treatment of hypertension, diabetes mellitus and other comorbid diseases. Regular clinic appointments are required to monitor for signs and symptoms of immunological injury, recurrent disease and adverse drug effects. Patients are instructed to avoid risk factors for cardiovascular disease and cancer (e.g. diet, exercise, sun protection and not smoking). Noncompliance with all aspects of this regimen is substantial. Medication noncompliance leads to an increased incidence of acute rejection, chronic rejection and graft loss. Undoubtedly, many practitioners fail to appreciate the extent of noncompliance as the signs are often subtle and most patients are unwilling to disclose deliberate or widespread disregard for medication use. Newer immunosuppressive agents, particularly once-daily medications and long-acting antibody preparations offer convenience and monitoring that may improve compliance. This review focuses on the prevalence, correlates and consequences of medication nonadherence after organ transplantation. Current recommendations to enhance adherence are discussed.
KeywordsTacrolimus Transplant Recipient Medication Adherence Acute Rejection Graft Loss
No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.
- 5.Marinker M, Blenkinsopp A, Bond C, et al., editors. From compliance to concordance: achieving shared goals in medicine taking. London: Royal Pharmaceutical Society of Great Britain, 1997Google Scholar
- 16.Vlaminck H, Maes B, Evers G, et al. Prospective study on late consequences of subclinical non-compliance with immunosuppressive therapy in renal transplant patients. Transplantation 2004; 4: 1509–13Google Scholar
- 38.Steiner R. Medication noncompliance: implications for transplant professionals [online]. Available from URL: http://www.medscape.com/viewprogram/3639 [Accessed 2006 May 5]
- 39.Aardex. MEMs [online]. Available from URL: http://www.aardex.ch/aardex/index.htm [Accessed 2006 May 23]