April 14, 2012

Should we retransplant a patient who is non-adherent? A literature review and critical reflection.


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Graft loss due to medication non-adherence remains a significant obstacle to optimal long-term outcomes for the transplant community. The decision to retransplant a patient who has been non-adherent to their medication regimen is one of ethical debate, yet little evidence exists to guide health professionals in this process. This manuscript sought to fill this gap by conducting a systematic review of the literature on outcomes of pediatric and adult patients who have been retransplanted following non-adherence to their immunosuppression. The authors found only one comprehensive paper which affirmed that nonadherence is prevalent and that outcomes are poorer in those retransplanted with overt nonadherence. However, they point out that much of nonadherence remains undetected so this may be an underestimation of the problem. This excellent review provides extensive discussion, insights and suggestions for best practice to address this important issue.

Cardiac Transplantation, Intestinal Transplantation, Liver Transplantation, Renal Transplantation, Transplant Infectious Disease

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