Transplantasyon Hastalarında İmmünosüpresif Tedaviye Uyumun Değerlendirilmesi

Year 2024, , 77 - 92, 31.03.2024

Ayşe Gül Atay Doyğacı , Sevil Güler

https://doi.org/10.25279/sak.1065784

Abstract

Giriş: Transplantasyon sonrası dönemde hastalarda rejeksiyonun önlenmesi için immünosüpresif ilaçları düzenli ve doğru bir şekilde yaşamları boyunca kullanmaları gerekmektedir.
Amaç: Bu çalışma böbrek, karaciğer ve kalp nakli yapılan hastalarda immünosüpresif tedaviye uyumu belirlemek amacıyla tanımlayıcı olarak yapıldı.
Gereç ve Yöntem: Araştırmanın örneklemini bir vakıf üniversitesi hastanesinde böbrek, karaciğer ve kalp nakli ve takipleri yapılan 60 hasta oluşturdu. Veriler, transplantasyon hastaları ile yüz yüze görüşülerek toplanmıştır. Hastaların kullandıkları immünosüpresif ilaçlar, hastane kayıtlarından karşılaştırıldı ve immünosüpresif tedavi planına uyumları belirlendi. Verilerin değerlendirilmesinde tanımlayıcı istatistikler, Spearman korelasyon katsayısı, Ki-kare ve Fisher Exact testleri kullanıldı.
Bulgular: Çalışmada hastaların %46.7'sine böbrek nakli, %36.7'sine karaciğer nakli, %13.3'üne kalp nakli ve %3.3'üne eş zamanlı böbrek-karaciğer nakli yapıldı. Tüm hastalara immünosüpresif tedavi uygulandı ve tedaviye uyum oranı %86.7 idi. Toplam immünosüpresif ilaç sayısı ile tedavi planına uygun kullanılan ilaç sayısı arasında anlamlı pozitif korelasyon bulundu (p<0.001). Hastaların tamamı düzenli olarak immünosüpresif ilaç kullanmaktaydı, %40.0'ında düzenli ilaç kullanımını etkileyen faktörler vardı ve ilk iki faktör immünosüpresif ilaç kullanmayı unutma (%70.8) ve uygun olmayan ilaç saatleri (%25.0) idi.
Sonuç: Sonuçlar, hastaların transplantasyon sonrası dönemde immünosüpresif tedaviye uyum ve uyumsuzluk faktörleri açısından düzenli olarak değerlendirilmesi gerektiğini göstermiştir. Hasta ve yakınlarına uyumu artırmak için programlar geliştirilmeli, eğitim ve danışmanlık verilmelidir.

Keywords

Uyum, Kalp Nakli, İmmünosupresif Tedavi, Böbrek Nakli, Karaciğer Nakli

Assessment of Immunosuppressive Therapy Adherence in Transplantation Patients

Abstract

Introduction: In the post-transplant period, patients should use immunosuppressive drugs regularly and correctly throughout their lives to prevent rejection.
Objectives: This descriptive study was conducted to determine adherence to immunosuppressive therapy in renal, liver and heart transplant patients.
Materials and Methods: The study sample consisted of 60 patients who underwent renal, liver, and heart transplantation and follow-up visits at a foundation university hospital. Data was collected by face-to-face interviews with transplantation patients. The immunosuppressive drugs used by the patients were compared from the hospital records and their compliance with the immunosuppressive treatment plan was determined. Descriptive statistics, Spearman correlation coefficient, Chi-squared, and Fisher Exact tests were used for data evaluation.
Results: In the study, renal transplantation was performed in 46.7% of the patients, liver transplantation in 36.7%, heart transplantation in 13.3%, and simultaneous renal-liver transplantation in 3.3%. All patients received immunosuppressive therapy and therapy adherence rate was 86.7%. A significant positive correlation was found between the total number of immunosuppressive drugs and the number of drugs used in line with the treatment plan (p<0.001). All patients had used immunosuppressive drugs regularly, 40.0% had the factors affecting regular drug use, and the first two factors were as follows: forgetting to use immunosuppressive drugs (70.8%), and inappropriate drug hours (25.0%).
Conclusion: The results showed that the patients should be evaluated regularly in terms of immunosuppressive therapy adherence and nonadherence factors in the post-transplantation period. Programs should be developed.

Keywords

Adherence, Heart Transplantation, Immunosuppressive Therapy, Kidney Transplantation, Liver Transplantation.

References

• Albekairy, A. M., Alkatheri, A. M., Jarab, A., Khalidi, N., Althiab, K., Alshaya, A., Saleh, K. B., Ismail, W. W. & Qandil, A. M. (2016). Adherence and Treatment Satisfaction in Liver Transplant Recipients. The Saudi Journal of Gastroenterology, 22(2), 127-132.
• Brahm, M. M. T., Manfro, R. C., Mello, D., Cioato, & Gonçalves, L. F. S. (2012). Evaluation of Adherence to Immunosuppressive Drugs in Kidney Transplantation by Control of Medication Dispensing. Transplantation Proceedings, 44, 2391–2393.
• Burra, P. et al., (2011). Adherence in Liver Transplant Recipients. Liver Transplantation, 17(7), 760-770.
• Butler, J. A., Roderıck, P., Mullee, M., Mason, J. & Peveler, R. C. (2004). Frequency and Impact of Nonadherence to Immunosuppressants After Renal Transplantation: A Systematic Review. Transplantation, 77(5), 769–789.
• Chisholm, M. A., Lancec, C. E., Williamsond, G. M. & Mulloye, L. L. (2005). Development and Validation of the Immunosuppressant Therapy Adherence Instrument (ITAS). Patient Education and Counseling, 59, 13-20.
• Chisholm, M. A., Mulloy, L. L., Jagadeesan, M. & Dipiro, J. T. (2001). Impact of clinical pharmacy services on renal transplant patients' compliance with immunosuppressive medications. Clinical Transplantation, 15, 330-336.
• Claxton, A. J., Cramer, J. & Pierce, C. (2001). A systematic review of the associations between dose regimens and medication compliance. Clinical Therapeutics, 23(8), 1296-1310.
• Ghods, A. J., Nasrollahzadeh, D. & Argani, H. (2003). Risk Factors for Noncompliance to Immunosuppressive Medications in Renal Transplant Recipients. Transplantation Proceedings, 35, 2609–2611.
• Gokoel, S. R., Gombert-Handoko, K. B., Zwart, T. C., van der Boog, P. J., Moes, D. J. A., & de Fijter, J. W. (2020). Medication non-adherence after kidney transplantation: A critical appraisal and systematic review. Transplantation Reviews, 34(1), 100511.
• Gonçalves, P. R. C., Reveles, A. F., Martins, H. I. F., Rodrigues, I. L. & Rodrigues, S. M. M. (2015). Adherence to Immunosuppressive Therapy in Kidney Transplant Recipients: Integrative Literature Review. Journal of Nursing Referência, 121-130.
• Gorevski, E. et al., (2013). Is there an association between immunosuppressant therapy medication adherence and depression, quality of life, and personality traits in the kidney and liver transplant population? Patient Preference and Adherence, 7, 301-307.
• Hansen, R., Seifeldin, R. & Noe, L. (2007). Medication Adherence in Chronic Disease: Issues in Posttransplant Immunosuppression. Transplantation Proceeding, 39, 1287-1300.
• https://www.irodat.org/?p=database , Accessed on: 27 May 2021.
• https://www.tonv.org.tr/tr/organ-bagisi/istatistikler/# , Accessed on: 21 May 2021.
• Kara, S., Salman, Z. & Ongel, K. (2012). Opinions of Suleyman Demirel University Medical Faculty Healthcare Personnel on Organ Donation. Ankara Health Services Journal, 11(1), 33-39.
• Karabulut, N., & Aktas, Y. Y. (2012). Problems of Patients After Liver Transplantation and Nursing Interventions. Balikesir Journal of Health Sciences, 1(1), 37-42.
• Kavurmacı, M., Karabulut, N. & Koç, A. (2014). Knowledge and Opinions of University Students on Organ Donation. Journal of Education and Research in Nursing, 11(2), 15-21.
• Kobus, G., Małyszko, J.,Małyszko, J. S., Puza, E., Bachórzewska-Gajewska, H. & Mysliwiec, M. (2011). Compliance with Lifestyle Recommendations in Kidney Allograft Recipients. Transplantation Proceedings, 43, 2930–2934.
• Lennerling, A., & Forsberg, A. (2012). Self-reported non-adherence and beliefs about medication in a Swedish kidney transplant population. The open nursing journal, 6, 41.
• Levine, D., Torabi, J., Choinski, K., Rocca, J. P., & Graham, J. A. (2019). Transplant surgery enters a new era: Increasing immunosuppressive medication adherence through mobile apps and smart watches. The American Journal of Surgery, 218(1), 18-20.
• Lieb, M., Hepp, T., Schiffer, M., Opgenoorth, M., & Erim, Y. (2020). Accuracy and concordance of measurement methods to assess non-adherence after renal transplantation-a prospective study. BMC nephrology, 21, 1-13.
• Low, K. J., Williams, A., Manias, E. & Crawford, K. (2015). Interventions to improve medication adherence in adult kidney transplant recipients: a systematic review. Nephrol Dial Transplant, 30, 752–761.
• Madran, B., Karayurt, Ö., Spivey, C. & Chisholm, M. A. (2016). Immunosuppressant Therapy Adherence Scale for Transplant Recipients: The Study of Validity and Reliability. Turkiye Klinikleri J Nurs Sci, 8(4), 325-334.
• Maglakelidze, N., Pantsulaia, T., Tchokhonelidze, I., Managadze, L. & Chkhotua, A. (2011). Assessment of Health-Related Quality of Life in Renal Transplant Recipients and Dialysis Patients. Transplantation Proceedings, 43, 376-379.
• Michelon, T., Dominguez, V., Losekan, A., Messias, A., Bruno, R., Bittar, A., Keitel, E., Santos, A. & Goldani, J. (1999). Kidney Graft Failure Due to Noncompliance. Transplantation Proceedings, 31, 3031–3032.
• Morales, J. M., Varo, E., & Lázaro, P. (2012). Immunosuppressant treatment adherence, barriers to adherence and quality of life in renal and liver transplant recipients in Spain. Clinical transplantation, 26(2), 369-376.
• Noens, L., Lierde, M. A., Bock, R., Verhoef, G., Zache´e, P., Berneman, Z., Martiat, P., Mineur, P., Eygen, K. V., MacDonald, K., Geest, S., Albrecht, A. & Abraham, I., (2009). Prevalence, determinants, and outcomes of nonadherence to imatinib therapy in patients with chronic myeloid leukemia: the ADAGIO study. Blood, 113(22), 5401-5411.
• Özdamar K. Statistical Data Analysis with Package Software. Extended 5th Edition, Kaan Publishing. Eskisehir, 2004; 661- 673.
• Özdemir, S. &Akın, P. (2003). Fulminant Liver Failure: Etiological, Clinical, and Prognostic Characteristics. Cerrahpasa Medical Journal, 34(1), 58-66.
• Papajcik, D., Mastroianni, B., Goormastic, M. & Flechner S.M. (1999). A Tool to Identify Risk Factors for Noncompliance in the Adult Renal Transplant Recipient. Transplantation Proceedings, 31, 84–86.
• Parikh, N. D. et al., (2015). Clinical Outcomes and Quality of Life in Recipients of Livers Donated after Cardiac Death. Hindawi Publishing Corporation Gastroenterology Research and Practice, 1-7.
• Perez, A. B. M., Suarez, L. A., Rodriguez, J. R., Marquez, J. M. S. & Galle, E. L. (2013). Medication Adherence in Patients Who Undergo Cardiac Transplantation. Transplantation Proceedings, 45, 3662-3664.
• Sahin, N. (2012). Investigating Drug Nonadherence and Causes and Expectations From Nurses After Liver Transplantation. Master Thesis, Institute of Health Sciences, Dokuz Eylul University, Izmir.
• Sahin, N. (2016). Adherence To Immunosuppressive Therapy After Liver and Kidney Transplantation and Affecting Factors. Master Thesis, Institute of Health Sciences, Dokuz Eylul University, Izmir.
• Sammani, A., Wind, A. M., Kirkels, J. H., Klöpping, C., Buijsrogge, M. P., Ramjakhan, F. Z., Asselbergs, F.W. & Jonge, N. (2017). Thirty years of heart transplantation at the University Medical Centre Utrech. Netherlands Heart Journal, 1-8.
• Sarıgöl, Y. (2008). Investigating quality of life before and after liver transplantation, Master Thesis, Department of Surgical Disease Nursing.
• Schneeberger, S. et al., (2014). Upper-Extremity Transplantation Using a Cell-Based Protocol to Minimize Immunosuppression. NIH Public Access, 257(2), 345-351.
• Tanrıverdi, M. H., Kardağ, A. & Hatipoğlu, E. Ş. (2010). Chronic Renal Failure. Konuralp Medical Journal, 2(2), 27-32.
• Villeneuve, C., Rousseau, A., Rerolle, J. P., Couzi, L., Kamar, N., Essig, M., ... & Monchaud, C. (2020). Adherence profiles in kidney transplant patients: causes and consequences. Patient education and counseling, 103(1), 189-198.
• Vlaminck, H. et al., (2004). Prospective Study on Late Consequences of Subclinical Non-Compliance with Immunosuppressive Therapy in Renal Transplant Patients. American Journal of Transplantation, 4, 1509–1513.
• Weng, F. L. et al., (2005). Race and Electronically Measured Adherence to Immunosuppressive Medications after Deceased Donor Renal Transplantation. Journal of the American Society of Nephrology, 16, 1839–1848.
• Yıldız, T. A., & Demir, S. G. (2009). Expectations of liver transplantation candidates and their relatives and difficulties they experience. Cukurova Medical Journal, 44(2), 669-684.