Karaciğer Transplantasyonu Yapılan Hastalarda İmmünsupresif İlaç Kullanımına Uyum: Tek Merkez Deneyimi

Yıl 2020, Cilt: 4 Sayı: 3, 88 - 95, 12.12.2020

Zeliha Özdemir Köken , Sabri Karahan , Rana Elçin Sezer , Osman Abbasoğlu

https://doi.org/10.46332/aemj.785045

Öz

Amaç: Bu çalışma karaciğer transplantasyonu yapılan hastalarda immünsupresif ilaç kullanımına uyumu belirlemek amacıyla yapılmıştır.

Araçlar ve Yöntem: Bu kesitsel-tanımlayıcı araştırma, Hacettepe Üniversitesi Karaciğer Nakil Merkezi’nde Aralık 2018- Eylül 2019 tarihleri arasında yürütülmüştür. Çalışmaya bu merkezde karaciğer transplantasyonu yapılmış olan 31 hasta dahil edilmiştir. Çalışma verileri “İmmünosupresif Tedaviye Uyum Ölçeği” ve “İmmünsupresif İlaç Kullanı-mına Uyum Ölçeği” kullanılarak elde edilmiştir.

Bulgular: Katılımcıların İmmünsupresif İlaç Kullanımına Uyum Ölçeği puan ortalaması 48.10±6.61 ve İmmünosup-resif Tedaviye Uyum Ölçeği puan ortalaması 10.90±1.16 olarak bulunmuştur. Her iki ölçekten elde edilen puanlara göre katılımcıların %13’ünün immünsupresif ilaç kullanımına uyumunun düşük olduğu saptanmıştır. İmmünsupresif İlaç Kullanımına Uyum Ölçeği puanları ile transplantasyon sonrası geçen süre arasında negatif yönde anlamlı bir ilişki saptanmıştır (r=-0.437, p=0.016). Katılımcıların İmmünosupresif Tedaviye Uyum Ölçeği puanları ile çalışma durumu arasında istatistiksel olarak anlamlı bir ilişki bulunmuştur (t=-2.357; p=0.026).

Sonuç: Karaciğer transplantasyon merkezlerinin, transplantasyon yapılan hastalarda immünsupresif ilaç kullanımına uyumunun çeşitli ölçüm araçları ile değerlendirilerek hasta gereksinimleri doğrultusunda uyumu iyileştirecek yöntem ve stratejiler geliştirilmesinin gerekli olduğunu düşünüyoruz.

Anahtar Kelimeler

immünsupresif ajan, karaciğer nakli, tedaviye uyum, tedaviye uyumsuzluk

Teşekkür

Yazarlar, çalışmanın uygulandığı Karaciğer Nakil Merkezinde görevli olan Organ Nakli Koordinatörlerine ve çalışmaya katılmaya gönüllü olan hastalara teşekkür eder.

Immunosuppressive Medication Adherence in Liver Transplant Patients: A Single Center Experience

Öz

Purpose: This study aimed to determine immunosuppressive medication adherence in patients with liver transplant.

Materials and Methods: This cross-sectional, descriptive study was conducted between December 2018 and Septem-ber 2019 in the Hacettepe University Liver Transplantation Center. A total of 31 patients who had liver transplanta-tion in this center were included in the study. Data of the study were obtained using "Immunosuppressive Therapy Adherence Scale" and "Immunosuppressive Medication Adherence Scale".

Results: The mean scores of the Immunosuppressive Medication Adherence Scale and the Immunosuppressive Thera-py Adherence Scale was 48.10 ± 6.61 and 10.90 ± 1.16, respectively. According to the scores obtained from both scales, it was determined that 13% of the participants had low immunosuppressive medication adherence. A signifi-cant negative correlation was found between the mean score of the Immunosuppressive Medication Adherence Scale and the time after transplantation (r=-0.437; p=0.016). A statistically significant relationship was found between the mean score of the Immunosuppressive Treatment Adherence Scale and the working status of the participants (t=-2.357; p=0.026).

Conclusion: We are of opinion that immunosuppressive medication adherence in liver transplant patients should be evaluated with various measurement tools and, liver transplantation centers need to develop methods and strategies to improve medication adherence according to the patient requirements.

Anahtar Kelimeler

immunosuppressive agents, liver transplantation, medication adherence, medication nonadherence

Kaynakça

• 1. Driscoll CJ, Gallagher L, Schaeffer MJ. Liver Transplanta-tion. Cupples S, Lerret S, McCalmont V, Ohler L, editors. Core curriculum for transplant nurses. 2. ed. China, Wolters Kluwer, 2017:413-452.
• 2. Sandwijk MS, Bemelman FJ, Berge IJM. Immunosuppres-sive Drugs After Solid Organ Transplantation. Neth J Med. 2013;71(6):281-289.
• 3. Brown M, Bussell JK. Medication Adherence: WHO Cares? Mayo Clin Proc. 2011;86(4):304-314.
• 4. Butler JA, Peveler RC, Roderick P, et al. Modifiable Risk Factors for Non-Adherence to Immunosuppressants in Re-nal Transplant Recipients: a cross-sectional study. Nephrol Dial Transplant. 2004;19(12):3144-3149.
• 5. Germani G, Lazzaro S, Gnoato F, et al. Nonadherent Behaviors After Solid Organ Transplantation. Transplant Proc. 2011;43(1):318-323.
• 6. Haynes RB, Ackloo E, Sahota N, Mcdonald HP, Yao X. Interventions for Enhancing Medication Adherence. Cochrane Database Syst Rev. 2008;16(2):CD000011
• 7. Sabate E. Adherence to Long-term Therapies: Evidence for Action, World Health Organization. https://www.who.int/chp/knowledge/publications/adherence_full_report.pdf?ua=1 Date of access: July 25, 2020.
• 8. Lieber SR, Volk ML. Non-adherence and graft failure in adult liver transplant recipients. Dig Dis Sci. 2013;58(3):824-834.
• 9. Kung M, Koschwanez HE, Painter L, Honeyman V, Broad-bent E. Immunosuppressant Nonadherence in Heart, Liver, and Lung Transplant Patients: Associations with Medication Beliefs and Illness Perceptions. Transplantation. 2012;93(9):958-963.
• 10. De Bleser L, Dobbels F, Berben L, et al. The Spectrum of Nonadherence with Medication in Heart, Liver, and Lung Transplant Patients Assessed in Various Ways. Transpl Int. 2011;24(9):882-891.
• 11. Jain M, Venkataraman J, Reddy MS, Rela M. Determinants of Medication Adherence in Liver Transplant Recipients J Clin Exp Hepatol. 2019;9(6):676–683.
• 12. Madran B, Karayurt Ö, Spivey CA, Chisholm-Bruns MA. Organ nakli alıcıları için immünosupresif tedaviye uyum ölçeği Türkçe geçerlik ve güvenirlik çalışması, Türkiye Klinikleri J. Nurs Sci. 2016;81(4):32-34.
• 13. Özdemir Köken Z, Talas MS, Gökmen D. Development and Psychometric Testing of the Turkish Immunosuppres-sive Medication Adherence Scale. Turk J Nephrol. 2019; 28(2):120-126.
• 14. IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.
• 15. O’Carroll RE, McGregor LM, Swanson V, Masterton G, Hayes PC. Adherence to medication after liver transplanta-tion in Scotland: a pilot study. Liver Transpl. 2006;12(12):1862-1868.
• 16. Burra P, Germani G, Gnoato F, et al. Adherence in liver transplant recipients. Liver Transpl. 2011;17(7):760-770.
• 17. Promraj R, Dumronggittigule W, Sirivatanauksorn Y, et al. Immunosuppressive Medication Adherence in Liver Trans-plant Recipients. Transplant Proc. 2016;48(4):1198-1201. 18. Couzi L, Moulin B, Morin MP, et al. Factors predictive of medication nonadherence after renal transplantation: a French observational study. Transplantation. 2013;95(2):326–332.
• 19. Burkhalter H, Wirz-Justice A, Cajochen C, et al. Daytime sleepiness in renal transplant recipients is associated with immunosuppressive non-adherence: a cross-sectional, multi-center study. Clin Transplant. 2014;28(1):58-66.
• 20. Massey EK, Tielen M, Laging M, et al. Discrepancies Between Beliefs and Behavior. Transplantation. 2015;99(2):375-380.
• 21. Berben L, Dobbels F, Kugler C, Russell CL, De Geest S. Interventions used by health care professionals to enhance medication adherence in transplant patients: a survey of current clinical practice. Prog Transplant. 2011;21(4):322-331.
• 22. Tao D, Xie L, Wang T, Wang T. A meta-analysis of the use of electronic reminders for patient adherence to medi-cation in chronic disease care. J Telemed Telecare. 2015;21(1):3-13.
• 23. Schwartz JK. Pillbox use, satisfaction, and effectiveness among persons with chronic health conditions. Assist Tech-nol. 2017;29(4):181-187.
• 24. Hardinger KL, Hutcherson T, Preston D, Murillo D. Influence of pill burden and drug cost on renal function af-ter transplantation. Pharmacotherapy. 2012;32(5):427-432.
• 25. Morales JM, Varo E, Lázaro P. Immunosuppressant treatment adherence, barriers to adherence and quality of life in renal and liver transplant recipients in Spain. Clin Transplant. 2012;26(2):369-376.
• 26. Belaiche S, Décaudin B, Dharancy S, Noel C, Odou P, Hazzan M. Factors relevant to medication non-adherence in kidney transplant: a systematic review. Int J Clin Pharm. 2017;39(3):582-593.
• 27. Goldfarb-Rumyantzev AS, Wright S, Ragasa R, et al. Factors associated with nonadherence to medication in kid-ney transplant recipients. Nephron Clin Pract. 2011;117(1):c33-c39.
• 28. Griva K, Davenport A, Harrison M, Newman SP. Non-adherence to immunosuppressive medications in kidney transplantation: intent vs. forgetfulness and clinical markers of medication intake. Ann Behav Med. 2012;44(1):85-93.