Non-adherence to post-transplant care: Prevalence, risk factors and outcomes in adolescent liver transplant recipients

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Non-adherence to post-transplant care: Prevalence, risk factors and outcomes in adolescent liver transplant recipients

Authors: Berquist, K.1; Berquist, E.1; Esquivel, O.1; , L.1; Wayman, I.1; Litt, Iris F.2

Source: Pediatric Transplantation, Volume 12, Number 2, March 2008 , pp. 194-200(7)

Publisher: Blackwell Publishing

Abstract:Berquist RK, Berquist WE, Esquivel CO, KL, Wayman KI, Litt IF. Non-adherence to post-transplant care: Prevalence, risk factors and outcomes in adolescent liver transplant recipients. Pediatr Transplantation 2007. © 2007 Blackwell Munksgaard Abstract:  This study examined the prevalence, demographic variables and adverse outcomes associated with non-adherence to post-transplant care in adolescent liver transplant recipients. We conducted a retrospective chart review of 111 adolescent patients (age 12-21 yr) greater than six months post-transplantation and defined non-adherence as not taking the immunosuppressive(s) or not attending any clinic visit in 2005. Fifty subjects (45.0%) were non-adherent and 61 (55.0%) were adherent. Twenty percent of the subjects did not attend clinic and 10.9% did not complete laboratory tests. Non-adherence was significantly associated with fewer completed laboratory tests (p < 0.0001), single parent status (p < 0.0186), and older age and greater years post-transplantation by both univariate and multivariate analyses (p < 0.008, p < 0.0141 and p < 0.0012, p < 0.0174, respectively). Non-adherence to medication was significantly associated with a rejection episode in 31 patients (p < 0.0069) but not in the subgroup of seven patients who stopped their immunosuppression completely. Non-adherence to post-transplant care is a prevalent problem in adolescents particularly of an older age and greater years post-transplantation. Rejection was a significant consequence of medication non-adherence except in a subgroup with presumed graft tolerance who discontinued their immunosuppression. These results emphasize the need for strict monitoring of adherence to post-transplant care to improve long-term survival and quality of life in adolescent transplant patients.

Keywords: patient non-adherence; pediatric liver transplantation; adolescents; long-term results; non-adherence

Document Type: Research article

DOI: 10.1111/j.1399-3046.2007.00809.x

Affiliations: 1: Departments of Pediatrics and Multi-Organ Transplantation, Stanford University Medical School, Palo Alto 2: Division of Adolescent Medicine, Stanford University Medical School, Palo Alto, CA, USA