Patient involvement in selection of immunosuppressive regimen following transplantation

Joyce Popoola,^1,3 Helen Greene,² Margaret Kyegombe,² Iain A MacPhee<sup>1,3

1</sup>Department of Nephrology and Transplantation, ²Department of Pharmacy, St George’s Healthcare NHS Trust, ³St George’s University of London, London, UK

Abstract: Transplantation has made a considerable difference to the lives of many patients. However, feedback from patients indicates that although having a transplant is a hugely positive experience, having to take medications indefinitely is one of the biggest challenges. An ideal scenario would be no medications following a transplant. A compromise would be a minimal number of medications, with minimal restrictions and as simple a regimen as possible. Although there is considerable research going into fine-tuning the management of the immune response to a transplant, to date there is no universal regimen that enables patients to remain free of immunosuppressant medications, making adherence paramount to maintain long-term allograft survival. This paper reviews the available immunosuppressant regimens and factors influencing choice from both the clinician’s and the patient’s perspective. Factors influencing the decision-making process, such as quality of life for patients, their satisfaction, acceptability, and adherence uptake are reviewed. We conclude with a further assessment of patient choice as a factor in regimen selection, its impact on adherence, and its implications.

Keywords: adherence, transplant, allograft, immunosuppressants, patient involvement, satisfaction, decision-making