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Author Notes:

Lara Danziger-Isakov, MD, MPH, 3333 Burnet Avenue, MLC 7017, Cincinnati, OH 45229, Office: 513-636-9101, lara.danziger-isakov@cchmc.org

See publication for full list of contributors.

We acknowledge feedback from Nancy Bridges at NIAID on the study design and interpretation of results.

Subject:

Research Funding:

The study was supported by a supplement to National Institutes of Health U01 grant (U01 AI077810) awarded to S. Sweet.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Pediatrics
  • Transplantation
  • adherence
  • pediatric
  • solid organ transplant
  • RECIPIENTS
  • OUTCOMES
  • REGIMEN

Perceived barriers to medication adherence remain stable following solid organ transplantation

Tools:

Journal Title:

PEDIATRIC TRANSPLANTATION

Volume:

Volume 23, Number 3

Publisher:

, Pages e13361-e13361

Type of Work:

Article | Post-print: After Peer Review

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.

Copyright information:

© 2019 Wiley Periodicals, Inc.

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