Individual and environmental correlates and predictors of early adherence and outcomes after liver transplantation

Context-Little is known about patients' contribution to health outcomes after liver transplantation. Yet, in other transplant recipients, nonadherent behavior is directly related to the leading causes of morbidity and mortality in liver transplant recipients. Objective-To examine patient and environmental factors in relation to all aspects of adherence to the posttransplantation regimen and health outcomes in the first 6 months after transplantation. Design-A descriptive analysis of individual and environmental factors in relation to adherence and health outcomes at 6 months after liver transplantation. Participants, Setting-One hundred fifty-two adult liver transplant recipients at the University of Pittsburgh Medical Center. Main Outcome Measures-Adherence to medication taking, appointment keeping, lifestyle changes, mood, quality of life, and clinical markers of liver function. Results -Nonadherence was prevalent (47% with appointments, 73% with medication); relapse to drug/alcohol use occurred among a few recipients (5.6%), all with a history of substance abuse before transplantation. Patterns of coping, decision making, attitude, and social support were correlated with adherence, clinical markers, and psychological function (r = 0.22-0.45). Avoidant coping, affective dysregulation, and caregiver support emerged as robust predictors of negative clinical and mental health outcomes (beta = .224-.363). Conclusion-This information about liver transplant recipients is important for researchers and clinicians. Researchers can develop guidelines by using stable but modifiable characteristics of patients to identify transplant candidates at risk of nonadherence. Such guidelines would enable clinicians to prepare patients better to manage the posttransplant regimen. (Progress in Transplantation. 2010;20:58-67)