Abstract

Adherence to a medical regimen has been defined as the extent to which a patient's behavior coincides with clinical prescriptions. In liver-transplanted patients adherence to immunosuppressive therapy, and to medical indications in general, is crucial to short- and long-term outcome. Non-adherence to immunosuppression carries a risk of graft rejection and potential graft loss, whereas non-adherence to general medical indication, such as avoiding alcohol intake and smoking after transplantation, may be associated with other complications, including de novo tumours, increasing health care costs. Among adult liver-transplanted patients non-adherence to immunosuppressive drugs ranges between 15 and 40%, while non-adherence to clinical appointments is in the range of 3-45% of cases. The wide range of reported rates is due to different definitions of non-adherence and the variety of methods used to measure adherence in the medical literature. Non-adherence seems to be nearly four times higher in pediatric and adolescent patients than in adult transplant recipients. Several non-adherence risk factors have been described among adult liver-transplanted patients, such as high costs of medication, psychiatric disorders, the conviction that the medication is harmful, and side-effects of immunosuppressive therapy. Risk factors for non-adherence in pediatric and adolescent liver-transplanted patients are psychological distress, the family's functional status, and the impact of immunosuppressive side effects on the patient's physical appearance. A single approach to promoting adherence to general medical prescriptions has proved ineffectual, so a multidisciplinary strategy should be adopted to achieve a significant improvement in this field. The present review aims to analyze all the published literature on adherence in liver-transplanted patients, focusing on the reported prevalence and the risk factors identified. Patients were split into age groups (adults or children/adolescents) because the scale of the problem and potential risk factors differ in the two groups

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