ETD

• aderenza terapeutica
• Trapianto di fegato

Using the integrative model of behavior prediction, we investigated the prevalence and outcome of self-reported non adherence (NA) to immunosuppression in 268 adult, de novo liver transplant (LT) recipients; the association between ‘non adherence’, ‘intention to adhere’ and ‘barriers to adhere’ (model 1), and the relationship between ‘intention to adhere’, ‘attitudes’, ‘norms’ and ‘self-efficacy’ (model 2). NA was measured by the Basel assessment of adherence to immunosuppressive medication scale (BAASIS) and patients were followed up for 5 years for evidence of the composite and components of efficacy failure (treated and/or biopsy proven acute rejection (t/BPAR), graft loss, and death).
NA was reported by 32.4% patients (87/268) and included timing deviations >2 hours in 23.5% (63/268), dose omissions in 8.5% (23/268), and dose reduction in 0.4% (1/268). Non adherers were younger (p = 0.001), had a higher risk for t/BPAR (12.6% vs. 2.8%; OR = 4.95; 95% CI=1.6-14.7), and experienced more frequent episodes of lower immunosuppressant blood levels vs. adherers (22.9% vs. 9.6%; p = 0.0047; OR 2.79; 95% CI = 1.3-5.6). In model 1, NA was predicted by barriers (OR 2.79; 95% CI 1.19-6.53; p = 0.01) and lower intention to adhere (OR 0.62; 95% CI 0.454-0.86; p= 0.004). In model 2, intention to adhere was predicted by being in favor of immunosuppression (OR 0.14; 95% CI 0.06-0.03; p<0.0001) and higher self-efficacy (OR 1.28; 95% CI 1.03-1.59; p=0.02).
NA is reported by one third of recipients and is associated with younger age and a higher risk for acute rejection. Intentions are influenced by cognitive factors (attitudes, self-efficacy), while NA is associated with barriers (forgetfulness) which can be targeted by interventions.