Late acute rejection and subclinical noncompliance with cyclosporine therapy in heart transplant recipients

S. De Geest, Ivo L Abraham, P. Moons, M. Vandeputte, J. Van Cleemput, G. Evers, W. Daenen, J. Vanhaecke

Research output: Contribution to journalArticle

147 Citations (Scopus)

Abstract

Background: Although noncompliance with immunosuppressive medication is recognized as a critical behavioral risk factor for late acute rejection episodes and graft loss after transplantation, little is known about the degree of subclinical cyclosporine noncompliance, its associated risk for acute late rejection episodes (>1 year after transplantation), and its determinants in heart transplant recipients. Methods: The convenience sample of this longitudinal study included 101 European heart transplant recipients (87 men and 14 women), with a median age of 56 (Q1 = 50, Q3 = 61) and a median posttransplantation status of 3 (range 1 to 6) years. Subclinical cyclosporine noncompliance was measured during a 3-month period with electronic event monitoring. Selected sociodemographic, behavioral, cognitive, emotional, health, and treatment-related determinants of medication noncompliance were measured by using instruments with established psychometric properties or by patient interviews. With the use of iterative partitioning methods of cluster analysis, including nonstandardized electronic event monitoring compliance parameters, patients were categorized by degree of subclinical cyclosporine noncompliance into a 3-cluster solution. Results: Overall compliance was high, with a median medication taking compliance of 99.4%. The 3 derived clusters, that is, excellent compliers (84%), minor subclinical noncompliers (7%), and moderate subclinical noncompliers (9%), differed significantly by degree of subclinical noncompliance (p < .0001) and showed a 1.19%, 14.28%, and 22.22% incidence of late acute rejections (p = .01), respectively. The 3 groups also differed in terms of former medication noncompliance (p = .02), appointment noncompliance (p = .03), and perceived self-efficacy with medication taking (p = .04). Conclusions: Although in absolute numbers cyclosporine compliance in this sample was high, minor deviations from dosing schedule were associated with an increased risk for acute late rejection episodes. This suggests a pivotal role of patient compliance in successful long-term outcome after transplantation.

Original languageEnglish (US)
Pages (from-to)854-863
Number of pages10
JournalJournal of Heart and Lung Transplantation
Volume17
Issue number9
StatePublished - 1998
Externally publishedYes

Fingerprint

Cyclosporine
Medication Adherence
Transplantation
Patient Compliance
Compliance
Appointments and Schedules
Graft Rejection
Self Efficacy
Therapeutics
Immunosuppressive Agents
Psychometrics
Cluster Analysis
Longitudinal Studies
Interviews
Transplant Recipients
Rejection (Psychology)
Incidence
Health

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Transplantation

Cite this

De Geest, S., Abraham, I. L., Moons, P., Vandeputte, M., Van Cleemput, J., Evers, G., ... Vanhaecke, J. (1998). Late acute rejection and subclinical noncompliance with cyclosporine therapy in heart transplant recipients. Journal of Heart and Lung Transplantation, 17(9), 854-863.

Late acute rejection and subclinical noncompliance with cyclosporine therapy in heart transplant recipients. / De Geest, S.; Abraham, Ivo L; Moons, P.; Vandeputte, M.; Van Cleemput, J.; Evers, G.; Daenen, W.; Vanhaecke, J.

In: Journal of Heart and Lung Transplantation, Vol. 17, No. 9, 1998, p. 854-863.

Research output: Contribution to journalArticle

De Geest, S, Abraham, IL, Moons, P, Vandeputte, M, Van Cleemput, J, Evers, G, Daenen, W & Vanhaecke, J 1998, 'Late acute rejection and subclinical noncompliance with cyclosporine therapy in heart transplant recipients', Journal of Heart and Lung Transplantation, vol. 17, no. 9, pp. 854-863.
De Geest, S. ; Abraham, Ivo L ; Moons, P. ; Vandeputte, M. ; Van Cleemput, J. ; Evers, G. ; Daenen, W. ; Vanhaecke, J. / Late acute rejection and subclinical noncompliance with cyclosporine therapy in heart transplant recipients. In: Journal of Heart and Lung Transplantation. 1998 ; Vol. 17, No. 9. pp. 854-863.
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abstract = "Background: Although noncompliance with immunosuppressive medication is recognized as a critical behavioral risk factor for late acute rejection episodes and graft loss after transplantation, little is known about the degree of subclinical cyclosporine noncompliance, its associated risk for acute late rejection episodes (>1 year after transplantation), and its determinants in heart transplant recipients. Methods: The convenience sample of this longitudinal study included 101 European heart transplant recipients (87 men and 14 women), with a median age of 56 (Q1 = 50, Q3 = 61) and a median posttransplantation status of 3 (range 1 to 6) years. Subclinical cyclosporine noncompliance was measured during a 3-month period with electronic event monitoring. Selected sociodemographic, behavioral, cognitive, emotional, health, and treatment-related determinants of medication noncompliance were measured by using instruments with established psychometric properties or by patient interviews. With the use of iterative partitioning methods of cluster analysis, including nonstandardized electronic event monitoring compliance parameters, patients were categorized by degree of subclinical cyclosporine noncompliance into a 3-cluster solution. Results: Overall compliance was high, with a median medication taking compliance of 99.4{\%}. The 3 derived clusters, that is, excellent compliers (84{\%}), minor subclinical noncompliers (7{\%}), and moderate subclinical noncompliers (9{\%}), differed significantly by degree of subclinical noncompliance (p < .0001) and showed a 1.19{\%}, 14.28{\%}, and 22.22{\%} incidence of late acute rejections (p = .01), respectively. The 3 groups also differed in terms of former medication noncompliance (p = .02), appointment noncompliance (p = .03), and perceived self-efficacy with medication taking (p = .04). Conclusions: Although in absolute numbers cyclosporine compliance in this sample was high, minor deviations from dosing schedule were associated with an increased risk for acute late rejection episodes. This suggests a pivotal role of patient compliance in successful long-term outcome after transplantation.",
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AU - De Geest, S.

AU - Abraham, Ivo L

AU - Moons, P.

AU - Vandeputte, M.

AU - Van Cleemput, J.

AU - Evers, G.

AU - Daenen, W.

AU - Vanhaecke, J.

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N2 - Background: Although noncompliance with immunosuppressive medication is recognized as a critical behavioral risk factor for late acute rejection episodes and graft loss after transplantation, little is known about the degree of subclinical cyclosporine noncompliance, its associated risk for acute late rejection episodes (>1 year after transplantation), and its determinants in heart transplant recipients. Methods: The convenience sample of this longitudinal study included 101 European heart transplant recipients (87 men and 14 women), with a median age of 56 (Q1 = 50, Q3 = 61) and a median posttransplantation status of 3 (range 1 to 6) years. Subclinical cyclosporine noncompliance was measured during a 3-month period with electronic event monitoring. Selected sociodemographic, behavioral, cognitive, emotional, health, and treatment-related determinants of medication noncompliance were measured by using instruments with established psychometric properties or by patient interviews. With the use of iterative partitioning methods of cluster analysis, including nonstandardized electronic event monitoring compliance parameters, patients were categorized by degree of subclinical cyclosporine noncompliance into a 3-cluster solution. Results: Overall compliance was high, with a median medication taking compliance of 99.4%. The 3 derived clusters, that is, excellent compliers (84%), minor subclinical noncompliers (7%), and moderate subclinical noncompliers (9%), differed significantly by degree of subclinical noncompliance (p < .0001) and showed a 1.19%, 14.28%, and 22.22% incidence of late acute rejections (p = .01), respectively. The 3 groups also differed in terms of former medication noncompliance (p = .02), appointment noncompliance (p = .03), and perceived self-efficacy with medication taking (p = .04). Conclusions: Although in absolute numbers cyclosporine compliance in this sample was high, minor deviations from dosing schedule were associated with an increased risk for acute late rejection episodes. This suggests a pivotal role of patient compliance in successful long-term outcome after transplantation.

AB - Background: Although noncompliance with immunosuppressive medication is recognized as a critical behavioral risk factor for late acute rejection episodes and graft loss after transplantation, little is known about the degree of subclinical cyclosporine noncompliance, its associated risk for acute late rejection episodes (>1 year after transplantation), and its determinants in heart transplant recipients. Methods: The convenience sample of this longitudinal study included 101 European heart transplant recipients (87 men and 14 women), with a median age of 56 (Q1 = 50, Q3 = 61) and a median posttransplantation status of 3 (range 1 to 6) years. Subclinical cyclosporine noncompliance was measured during a 3-month period with electronic event monitoring. Selected sociodemographic, behavioral, cognitive, emotional, health, and treatment-related determinants of medication noncompliance were measured by using instruments with established psychometric properties or by patient interviews. With the use of iterative partitioning methods of cluster analysis, including nonstandardized electronic event monitoring compliance parameters, patients were categorized by degree of subclinical cyclosporine noncompliance into a 3-cluster solution. Results: Overall compliance was high, with a median medication taking compliance of 99.4%. The 3 derived clusters, that is, excellent compliers (84%), minor subclinical noncompliers (7%), and moderate subclinical noncompliers (9%), differed significantly by degree of subclinical noncompliance (p < .0001) and showed a 1.19%, 14.28%, and 22.22% incidence of late acute rejections (p = .01), respectively. The 3 groups also differed in terms of former medication noncompliance (p = .02), appointment noncompliance (p = .03), and perceived self-efficacy with medication taking (p = .04). Conclusions: Although in absolute numbers cyclosporine compliance in this sample was high, minor deviations from dosing schedule were associated with an increased risk for acute late rejection episodes. This suggests a pivotal role of patient compliance in successful long-term outcome after transplantation.

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