TY - JOUR
T1 - Perceived barriers to medication adherence remain stable following solid organ transplantation
AU - the CTOTC-05 Consortium
AU - Danziger-Isakov, Lara
AU - Frazier, Thomas W.
AU - Worley, Sarah
AU - Williams, Nikki
AU - Shellmer, Diana
AU - Dharnidharka, Vikas R.
AU - Gupta, Nitika A.
AU - Ikle, David
AU - Shemesh, Eyal
AU - Sweet, Stuart C.
AU - Harmon, William
N1 - Funding Information:
This research was performed as a project of the CTOTC, a col‐ laborative clinical research project headquartered at the National Institute of Allergy and Infectious Diseases. The study was sup‐ ported by a supplement to National Institutes of Health U01 grant (U01 AI077810) awarded to S. Sweet. We acknowledge feedback from Nancy Bridges at NIAID on the study design and interpretation of results.
Funding Information:
This research was performed as a project of the CTOTC, a collaborative clinical research project headquartered at the National Institute of Allergy and Infectious Diseases. The study was supported by a supplement to National Institutes of Health U01 grant (U01 AI077810) awarded to S. Sweet. We acknowledge feedback from Nancy Bridges at NIAID on the study design and interpretation of results. The CTOTC-05 consortium members thank the following personnel for the support of the work: Boston Children's Hospital, Boston MA: William Harmon, Leslie Spaneas, Erin Leone Thakkallapalli, Kate Garrigan, Molly O'Brien, Beatrice Dubert, Stephanie Valcourt-Dexter; Children's Hospital of New York, New York, NY: Linda Addonizio, Warren Zuckerman, Rose Rodriguez; Children's Hospital of Philadelphia: Samuel Goldfarb, Rosa Kim, Sara Nguyen; Children's Hospital of Pittsburgh: Steven Webber, Brian Feingold, Shawn West, Jane Luce; Children's Hospital Seattle: Ruth McDonald, Jodi Smith, Robert Johnson; Cleveland Clinic, Cleveland, OH: Johanna Goldfarb, Donna Lach; Emory University: Sandra Amaral, Verena Weissenborn, Rachel Dodd, Gail Schwartz, Monica Haughton, Lu Arechiga; Lucile Packard Children's Hospital at Stanford, Palo Alto, CA: Carol Conrad, Emily Orbe, Nirvi Mistry, Elisabeth Merkel, Suvarna Bhamre; Mattel Children's Hospital at UCLA, Los Angeles, CA: Eileen Tsai, Maggie Holloway, Claire White; Nationwide Children's Hospital, Columbus, OH: Don Hayes, Stephen Kirkby, Ashley Nance, Kerri Nicholson, Susan Meyer; Shands Children's Hospital, Gainesville, FL: Tracie Kurtz; St. Louis Children's Hospital, St. Louis, MO: Colleen Eisenbarger; Texas Children's Hospital, Houston, TX: George Mallory, Marc Schecter, Tina Melicoff, Janet Bujan, Charles Sellers, Nicoline Schaap, Mea Ebenbichler; University of Alabama, Birmingham, AL: David Askenazi, Dan Feig, Amy Logue, Stephanie Clevenger, Rajesh Koralkar, Susan Keeling; University of California, San Francisco, CA: Marsha Lee, Stephanie Lemp, Jenny Chu, Vino Laksshamanan.
Publisher Copyright:
© 2019 Wiley Periodicals, Inc.
PY - 2019/5
Y1 - 2019/5
N2 - Perceived barriers to adherence have previously been investigated in SOT to identify plausible intervention targets to improve adherence and transplant outcomes. Fifteen centers in CTOTC enrolled patients longitudinally. Patients >8 years completed Adolescent Scale(AMBS) at two visits at least 6 months apart in the first 17 months post-transplant while their guardians completed PMBS. Differences over time for pre-identified AMBS/PMBS factors were analyzed. Perceived barrier reporting impact on subsequent TAC levels was assessed. A total of 123 patients or their guardians completed PMBS or AMBS. Twenty-six were 6-11 years and 97 were ≥12. The final cohort consisted of kidney (66%), lung (19%), liver (8%), and heart (7%) recipients. Unadjusted analysis showed no statistically significant change in reported barriers from visit 1 (median 2.6 months, range 1.2-3.7 post-transplant) to visit 2 (median 12, range 8.9-16.5). Of 102 patients with TAC levels, 74 had a single level reported at both visits. The factor of “Disease frustration” was identified through the PMBS/AMBS questions about fatigue around medication and disease. Each point increase in “disease frustration” at visit 1 on the AMBS/PMBS doubled the odds of a lower-than-threshold TAC level at visit 2. No clear change in overall level of perceived barriers to medication adherence in the first year post-transplant was seen in pediatric SOT. However, disease frustration early post-transplant was associated with a single subtherapeutic TAC levels at 12 months. A brief screening measure may allow for early self-identification of risk.
AB - Perceived barriers to adherence have previously been investigated in SOT to identify plausible intervention targets to improve adherence and transplant outcomes. Fifteen centers in CTOTC enrolled patients longitudinally. Patients >8 years completed Adolescent Scale(AMBS) at two visits at least 6 months apart in the first 17 months post-transplant while their guardians completed PMBS. Differences over time for pre-identified AMBS/PMBS factors were analyzed. Perceived barrier reporting impact on subsequent TAC levels was assessed. A total of 123 patients or their guardians completed PMBS or AMBS. Twenty-six were 6-11 years and 97 were ≥12. The final cohort consisted of kidney (66%), lung (19%), liver (8%), and heart (7%) recipients. Unadjusted analysis showed no statistically significant change in reported barriers from visit 1 (median 2.6 months, range 1.2-3.7 post-transplant) to visit 2 (median 12, range 8.9-16.5). Of 102 patients with TAC levels, 74 had a single level reported at both visits. The factor of “Disease frustration” was identified through the PMBS/AMBS questions about fatigue around medication and disease. Each point increase in “disease frustration” at visit 1 on the AMBS/PMBS doubled the odds of a lower-than-threshold TAC level at visit 2. No clear change in overall level of perceived barriers to medication adherence in the first year post-transplant was seen in pediatric SOT. However, disease frustration early post-transplant was associated with a single subtherapeutic TAC levels at 12 months. A brief screening measure may allow for early self-identification of risk.
KW - adherence
KW - pediatric
KW - solid organ transplant
UR - http://www.scopus.com/inward/record.url?scp=85061437976&partnerID=8YFLogxK
U2 - 10.1111/petr.13361
DO - 10.1111/petr.13361
M3 - Article
C2 - 31332928
AN - SCOPUS:85061437976
SN - 1397-3142
VL - 23
JO - Pediatric Transplantation
JF - Pediatric Transplantation
IS - 3
M1 - e13361
ER -