Immunsuppressiva-Adhärenz nach Transplantation

Zusammenfassung

Die Transplantation stellt für viele Patienten mit chronischem Organversagen die bestmögliche und teilweise einzige Therapieoption dar. Häufig erleben die Patienten nach erfolgreicher Transplantation eine deutliche Verbesserung ihres Zustandes, allerdings sind sie nicht geheilt sondern noch immer chronisch krank. Das Leben mit dem transplantierten Organ erfordert die konsequente Einnahme immunsuppressiver Medikation, regelmäßige Arztbesuche und die Befolgung von Empfehlungen zur Infektionsvermeidung. Diese Faktoren sind wichtig für ein langes Transplantatüberleben. Besonders die Non-Adhärenz zur immunsuppressiven Medikation ist ein Risikofaktor für Abstoßung des Transplantats. Die Gründe für non-adhärente Verhaltensweisen sind vielfältig. Allerdings ist es von großer Bedeutung die individuellen Gründe genau zu identifizieren, um ihnen angemessen begegnen zu können. Ziel dieses Artikels ist es, einen Überblick über Adhärenz beeinflussende Faktoren zu geben, Möglichkeiten zur Adhärenzerfassung vorzustellen, sowie verschiedene Ansätze zu präsentieren, um die Adhärenz zu verbessern. Randomisiert-kontrollierte Interventionsstudien werden vorgestellt und davon ausgehend Empfehlungen für die Praxis abgeleitet.

Abstract

Organ transplantation is the best and to some extent only option for many patients with chronic organ failure. Usually after successful transplantation patients experience a significant improvement of their condition. Nevertheless, they are not cured but still chronically ill. Living with an organ transplant requires consequent immunosuppression intake, regular physician visits and following the recommendations regarding infection prevention. These factors are important to secure a long transplant survival. Especially non-adherence to immunosuppressants is known as a risk factor for transplant rejection. There are several reasons for non-adherent behavior. However identifying the individual motivations is crucial for addressing them correctly. The aim of this article is to give an overview of factors influencing adherence, to introduce options to assess adherence and to present ways to improve adherence. Randomized-controlled intervention studies are presented and on that basis recommendations for clinical practice are derived.

Schlüsselwörter

Adhärenz - Organtransplantation - Immunsuppression - Interventionen

Key words

adherence - organ transplantation - immunosuppression - interventions

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