• terapia immunosoppressiva
• trapianto di fegato

There are no easy challenges in current medical practice. This is due to the intricacy of human nature as well as to the complexity of medical interventions to be implemented for patients in need.
Over the recent years, focus has been directed to the mechanisms of drug non-adherence across individuals and communities, in view of designing solutions to improve the results of therapeutic programs. Treatments are getting more complex, and may often challenge patients, their families, and the communities. The ever-increasing demand on the part of the patients is not only to be treated, but to get help irrespective of the outcome. Non-adherence may not only be a source of morbidity, but it is a request for help from those in need. Non adherers to treatment programs - even to a limited extent – are to be taken care of, due to the anticipated risk of treatment failure and because they may have not entirely understood the objectives of their therapeutic plan.
The most appropriate approach to explore non-adherence is the ecological perspective. This latter mandates to explore all levels involved in delivering care for the individual and the communities: the micro-level between patients and their care providers; the meso-level of health care organizations, and the macro-level, that is, the socio-political environment.
Based on such ecological perspective, the current work illustrates the research that has been carried out on patient adherence at the Liver transplant center of the University Hospital of Pisa. This work has been conducted in collaboration with colleague nurses, physicians, students, and trainees, and investigated the prevalence of non-adherence at the individual level, explored the level of organization of regional transplant centers, and illustrates the patient-centered educational program implemented at our center.