AUTHOR=Wagner-Skacel Jolana , Fink Nadja , Kahn Judith , Dalkner Nina , Jauk Emanuel , Bengesser Susanne , Mairinger Marco , Schüssler Gerhard , Pieh Christoph , Stadlbauer Vanessa , Kirsch Alexander H. , Zitta Sabine , Rosenkranz Alexander R. , Fickert Peter , Schemmer Peter 

TITLE=Improving adherence to immunosuppression after liver or kidney transplantation in individuals with impairments in personality functioning – A randomized controlled single center feasibility study

JOURNAL=Frontiers in Psychology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2023.1150548

DOI=10.3389/fpsyg.2023.1150548

ISSN=1664-1078

ABSTRACT=Introduction: Although adherence to immunosuppressive medication is the key factor for long-term graft survival today, 20-70% of transplant recipients are non-adherent to their immunosuppressive medication.
Objective: A prospective, randomized, controlled single-center feasibility study was designed to evaluate the impact of a step guided multicomponent interprofessional intervention program for patients after kidney or liver transplantation on adherence to their immunosuppressive medication in daily clinical practice. 

Methods: The intervention consisted of group therapy and daily training as well as individual sessions in a step guided approach. The primary endpoint of study was adherence to immunosuppression as assessed with the “Basel Assessment of Adherence to Immunosuppressive Medications Scale” (BAASIS). The coefficient of variation (CV%) of Tacrolimus (TAC) through levels and the level of personality functioning was a secondary endpoint. We conducted six monthly follow-up visits.

Results: Forty-one age-and sex-matched patients (19 females, 58.5 (SD = 10.56) years old, 22 kidney- and 19 liver transplantation) were randomized to the intervention- (N = 21) or control-group (N = 20). No differences between intervention- and control groups were found in the primary endpoint adherence and CV% of TAC. However, in further exploratory analyses, we observed that individuals with higher impairments in personality functioning showed higher CV% of TAC in the controls. The intervention might compensate personality-related susceptibility to poor adherence as evident in CV% of TAC.

Discussion: The results of the feasibility study showed that this intervention program was highly accepted in the clinical setting. The Intervention group could compensate higher CV% of TAC after liver or kidney transplantation in individuals with lower levels of personality functioning and non-adherence.

Trial registration: ClinicalTrials.gov, NCT04207125. Registered on 20 November 2019.