NON ADHERENCE TO MEDICAL PRESCRIPTIONS IN LIVER TRANSPLANTATION: A PROSPECTIVE LONGITUDINAL STUDY

Introduction: Adherence to medical prescription in patients undergoing liver transplantation (LT) is mandatory to ensure patient and graft long-term survival. Aim: the aim was to evaluate adherence to medical regimen before and after LT. Material and methods: Patients with liver cirrhosis, referred to our Multivisceral Transplant Unit for LT evaluation (2005-2006), were enrolled. Liver transplanted patients were followed-up at 6 and 12 months after LT. All patients underwent anonymous questionnaire, blood tests including immunosuppressive drugs (IS) blood levels after LT. Results: 134 patients (100 M, mean age 53.3±7.6) were enrolled. Before LT 44%, 12.7% and 13.4% of patients were non adherent to therapy, to outpatient visit and to requested blood tests, respectively. Non adherent vs. good adherent patients, were younger (p=0.04) and unmarried (p=0.03). At multivariate analysis being divorced (OR 4.01, 95%CI 1.17-13.74) and a better MELD score at LT (OR 2.31, 95%CI 1.06-5.02) were independent risk factors for non adherence before LT. 27/134 (20.1%) patients underwent LT during the study period. At 6 months after LT 15%, 20% and 10% of patients were non adherent to therapy, to outpatient visit and to requested blood tests, respectively. Non adherent vs. good adherent patients had better MELD at LT (p=0.04), were drinking alcohol (p=0.001) and reported >3 side effects of IS (p=0.02). At 12 months after LT 60%, 50% and 50% of patients were non adherent to therapy, to outpatient visit and to requested blood tests, respectively, significantly worse compared to 6 months evatuation. Non adherent vs. good adherent patients, were younger (p=0.05), had better MELD at LT (p=0.04), were drinking alcohol (p=0.001) and reported >3 side effects of IS (p=0.02). 50% of patients with poor adherence after LT, had poor adherence before LT. Conclusions: Adherence to medical regimen is poor in cirrhotic patients being the risk factors to be divorced and having good liver function. It seems that adherence improves in the short-term, but deteriorates again in the longer time after LT, when being relatively stable at LT and experiencing side effects due to IS are associated with poor adherence. Educational programs for such patients are badly needed.