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P6.03 Traumatic events and treatment non-adherence: a potential association?

Daniel Osvaldo O Merino, Argentina

Coordinator of Psichology
Nephrology and kidney transplant division
Hospital General de Agudos Dr. Cosme Argerich

Abstract

Traumatic events and treatment non-adherence: a potential association?

Mariela Miranda1, Daniel Merino1, Guillermo Martinez1, Ruben Schiavelli1.

1Division of Nephrolgy and Renal Transplant, Hospital General de Agudos Cosme Argerich, Caba, Argentina

Introduction: Organ transplantation requires, as an essential part of the treatment, adherence to immunosuppressive medication. In adolescent patients, treatment non-adherence rates are higher than in adults and, in some cases, may be associated with experiencing traumatic situations. There is little information on how such an event could lead adolescent patients to discontinue their immunosuppressive medication, thus putting the transplanted organ at risk.

Objective: To describe treatment adherence and its association with traumatic events in adolescent kidney transplant patients. To describe patients’ perception of satisfaction with their transplant.

Methods: A semi-directed telephone survey of adolescent kidney transplant patients was carried out. The SMAQ test (Simplified Medication Adherence Questionnaire) and the Davidson Trauma Scale were used.

Results: Thirty-two kidney transplant patients (TXPs) were interviewed, 17 of whom were female. Their average age was 21±1.8 years. Their education level was: completed secondary school in 14 TXPs (43.7%); incomplete secondary school in 9 TXPs (28.12%); incomplete tertiary education in 7 TXPs (21.87%); and incomplete primary school in 2 TXPs (6.24%). Cohabitants were parents for 22 TXPs (68.7%) and partners for 10 TXPs (31.3%). The average length of time after transplantation was 8.41 years (1-16). Thirty-one Ps were transplanted from deceased donors and 1 P, from a living donor. Non-adherence was found in 28 TXPs (87%) and only 4 TXPs were adherent (12.5%).  Nine TXPs (28.12%) were diagnosed with acute rejection, all of whom were non-adherent.  Three TXPs (9.37%) experienced traumatic events, all of whom were non-adherent. Of the 28 non-adherent TXPs, only 3 (10.7%) considered traumatic events as a cause. When asked about the transplant perception, 25 TXPs (78.1%) answered that it had improved their quality of life; 5 TXPs (15.62%) stated that they were satisfied with the transplant; and 2 TXPs (6.24%) did not mention any changes. Thirteen (43.3%) of the 30 TXPs who stated an improved quality of life or satisfaction with their transplant answered that stopping dialysis was the most important change to them.

Conclusion: Non-adherence is still a problem within this population. The incidence of traumatic events, even though it was low, resulted in non-adherence. Non-adherence cannot be accounted for by dissatisfaction with the transplant as most Ps answered positively about it. Stopping the dialysis treatment was the most valued outcome of their transplant.

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