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CME

Medication Noncompliance: Implications for Transplant Professionals

  • Authors: Author: Robert Steiner, MD
  • THIS ACTIVITY HAS EXPIRED
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Target Audience and Goal Statement

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:

  1. Identify common reasons for medication noncompliance among solid organ transplant recipients.
  2. Recognize signs and symptoms suggestive of medication noncompliance in the solid organ transplant recipient.
  3. List strategies that the physician can use to help patients be compliant with their immunosuppressive medications.


Disclosures

As an organization accredited by the ACCME, Medscape requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as "financial relationships in any amount, occurring within the past 12 months, that create a conflict of interest."

Medscape encourages Authors to identify investigational products or off-label uses of products regulated by the U.S. Food and Drug Administration, at first mention and where appropriate in the content.


Author(s)

  • Robert Steiner, MD

    Chief, Transplant, Nephrology, University of California San Diego, San Diego, California

    Disclosures

    Disclosure: Robert Steiner, MD, has disclosed that he has received grants for clinical research from Wyeth.


Accreditation Statements

    For Physicians

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CME

Medication Noncompliance: Implications for Transplant Professionals

Authors: Author: Robert Steiner, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

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Introduction

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.