Interventions for improving adherence in solid organ transplant recipients

Abstract

Background: Adequate immune system suppression is required for survival of a solid organ transplant, thus immunosuppressive therapy forms the central part of treatment following an organ transplant. Odds of organ failure increase seven-fold for non-adherent individuals, consequently, identification of successful modes of intervention to improve adherence to immunosuppressant therapy is required. Objective: This review aims to look at the benefits and harms of using interventions for improving adherence to immunosuppressant therapies in solid organ transplant recipients. Methods: Studies: All RCTs, quasi-RCTs and cluster RCTs examining interventions to improve adherence following a solid organ transplant. Study population: Adult and paediatric solid organ transplant recipients. Interventions: Studies addressing interventions to improve adherence to immunosuppressant medication in comparison to a control arm will be included. Comparisons of interventions to usual routine care will also be included. Given the wide variation in types of interventions to address adherence, and methods of adherence measurement, interventions of any sort intended to affect adherence with prescribed, self-administered medications will be included. A combination intervention including one or more strategies will be included. Primary outcome: Adherence to immunosuppressant medication. Expected results: This proposed Cochrane Review will provide the highest form of evidence for improving adherence post-transplantation. Current stage of work: Review Protocol submitted to Cochrane Kidney and Transplant Group Conclusions: Given the reported high non-adherence rates, coupled with the critical importance of adherence to the immunosuppressant regimen to maximise and maintain successful transplantation, clear evidence is required to identify effective ways to improve adherence post-transplant.