Sunday, October 1, 2023
This activity is intended for physicians and other providers who care for solid organ transplant recipients.
The goal of this activity is to describe the problem of medication noncompliance after solid organ transplantation and provide recommendations for prevention of and interventions for this problem with potentially catastrophic consequences.
Upon completion of this activity, participants will be able to:
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Medscape designates this educational activity for a maximum of 1.0 category 1 credit(s) toward the AMA Physician's Recognition Award. Each physician should claim only those credits that reflect the time he/she actually spent in the activity.
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consult your professional licensing board.
This activity is designed to be completed within the time
designated on the title page; physicians should claim only those
credits that reflect the time actually spent in the activity. To
successfully earn credit, participants must complete the activity
online during the valid credit period that is noted on the title page.
Follow these steps to earn CME/CE credit:
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Although significant progress has been made in solid organ transplantation since its beginnings in the 1960s, and particularly during the past 10 years, immunosuppressive drugs must still be taken life-long by solid organ transplant recipients to prevent graft loss caused by acute and chronic rejection. When immunosuppressive regimens were simpler and less effective (ie, prednisone and azathioprine [AZA]), there was perhaps less reason to suspect medication noncompliance as a contributing factor to acute and chronic rejection. In the current era, acute postoperative rejection is uncommon and medication noncompliance has emerged as an increasingly important factor in the ongoing clinical management of organ transplant recipients, having been clearly demonstrated to play a role in acute rejection, chronic rejection, and graft loss.[1]
Although there are other manifestations of noncompliance in transplant recipients (ie, failure to keep scheduled clinic visits or obtain ordered laboratory tests), medication noncompliance is more difficult to recognize and is the most important form of noncompliance in this patient population for several reasons: (1) just as adequate drug exposure in patients who take their medications as prescribed has a positive effect on outcome, limiting drug exposure by failure to take medications altogether has a far more negative effect; (2) detection of potential noncompliance preoperatively should be taken into consideration in the patient evaluation and selection process and trigger initiation of preoperative counseling; (3) the ability to quantify patient noncompliance in drug trials would help separate patient behavioral factors from biologic efficacy; and (4) identification of patients at high risk for noncompliance at any time before or after transplantation should lead to an effective team strategy to minimize its effect on long-term transplant survival.
This review will focus on compliance with medications prescribed to renal transplant recipients. Commonalities that may help clinicians identify patients for early intervention will be discussed. Although many questions remain unanswered, new methodologies, such as electronic pill bottle monitors, provide opportunities to more effectively study medication noncompliance and its risk factors, and offer the potential for earlier intervention and improved outcomes.
