Preventiontreatment Of Noncompliance

Today newer medication protocols have minimized the immunologic risk of rejection, however that very progress increasingly highlights the issue of patient noncompliance. At a practical level, the challenge for each physician and caregiver is to become more acutely aware of this clinical problem. At the same time we need to increase both our efforts to improve compliance as well as removing recognized barriers to compliance (Table E7.2).

Clearly, patient groups at higher risk for noncompliance can now be identified by demographic factors or by medication monitor technology. But at present there are no prospective randomized trials in transplant recipients to demonstrate effective strategies to improve compliance. While changing human behavior is difficult, data from the Diabetes Control and Complications Trial suggest that intensive interventions may be associated with overall improvement in compliance and better outcomes.16

Unfortunately, intervention studies are difficult and expensive. Still the obvious costs (human and financial) of graft failure and return to dialysis are even higher. Now is an appropriate time to begin such studies in transplant recipients, so every patient may fully benefit from the progress already made in transplantation.

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