| Summary: | 碩士 === 慈濟大學 === 護理學系碩士班 === 100 === With advances in medical technology, organ transplantation has become an emerging surgical treatment for organ failure. However, transplant recipients have to take lifelong immunosuppressive agents in order to maintain good graft function. Non-adherence of the immunosuppressive medications may affect the transplanted graft function, reduce the quality of life, threaten live or even cause death, which adds to medical burdens and social costs. The purpose of this study is base on the World Health Organization（WHO）adherence model to explore the factors associated with adherence of immunosuppressive therapy among liver and kidney transplant recipients.
Cross-sectional design, and purposive sampling were used to recruit subjects who had received kidney or liver transplants from a medical center in eastern Taiwan. A total of 116 cases were selected from January to April 2012, including 96 kidney recipients （82.8%）, 18 liver recipients（15.5%）and two liver and kidney recipients（1.7%）. The mean age was 50.9±10.67 years old, and 56.9% of recipients were male. Reported adherence rate to immunosuppressive therapy was 39.7%, and to clinical appointments was 81%. Immunosuppressant serum concentration stability ratio was 62.1%. Further analysis found the immunosuppressive therapy adherence related factors were socio-economic factors: the level of education（r = -.252, p< .01）, the residence distance（r = .229, p <.05）; condition factors: the complexity of co-morbidity（r = - .187, p <.05）; and treatment factors: time since transplantation (r = - .246, p <.01), medication behavior（r = - .304, p <. 01）. The clinical appointments adherence related factors were socio-economic factors: age （r = .187, p <.05), and condition factors: quality of life（r = .245, p <.01）. Immunosuppressant serum concentration stability had related only to the therapy factors: the total number of immunosuppressants（r = .184, p <.05）, total number of medications（r = .200, p <.05）, and organ from deceased donor（r = - .189, p <.05）. Further logistic regression analysis found: the risk factors of the immunosuppressive therapy adherence include socio-economic, condition and therapy factors. The clinical appointments adherence related risk factors included socio-economic, condition and treatment factors. Immunosuppressant serum concentration instability related risk factors were patient factors.
The results of this study found that the adherence rate to immunosuppressive therapy and clinical appointments were 39.7% and 81% respectively. Since the cut-off point of immunosuppressive therapy adherence rate was set at 100% to reflect the clinical immunosuppressants adherence. The patients should be absolutely adhered with immunosuppresants to maintain the function of transplanted organs. Therefore, adherence to immunosuppressive therapy is obviously poor in clinical settings. So, patient education on absolute immunosuppresants adherence should be emphasized. The clinical appointment adherence rate from our patients was excellent（81%）, which may be contributed to fulltime case management by nursing coordinators.
This study is the first domestic study to investigate immunosuppresive adherence utilizing questionnaire in combination with clinical appointments, immunosuppressant serum concentration and graft function. It provides objective information of laboratory data to reduce inaccuracy of subjective assessments. This research reveals preliminary domestic results of immunosuppresive adherence for further clinical reference. Screening patients of potentially non-adherence by employing Immunosuppressant Therapy Adherence Scale (ITAS) is practical, further intensive case management and reinforced patient education is suggested for those patients.
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