title: Nonadherence is associated with late rejection in pediatric heart transplant recipients.
abstract: OBJECTIVE
  The objective was to study the impact of nonadherence on late rejection after pediatric heart transplantation.
  
  
  METHODS
  This was a retrospective cohort study of cardiac transplant recipients surviving >6 months (n = 50). Patients were stratified by episodes of late rejection. End points were defined by cyclosporin A (CSA) level, CSA level variability, and patient admission of nonadherence.
  
  
  RESULTS
  In 15 patients there were 49 episodes of late rejection, and 37 (76%) were associated with nonadherence. Of these patients, 7 of 15 died, and 3 of 15 had transplant coronary artery disease. Risk factors for the rejection were single-parent home, non-white, older age, and higher CSA level variability. In 35 nonrejectors there were 4 deaths from sepsis, post-transplant lymphoproliferative disease, renal failure, and encephalomyelitis.
  
  
  CONCLUSIONS
  Late rejection after pediatric heart transplantation is associated with nonadherence, is common during adolescence, and is associated with poor outcome.
authors.affiliation: Department of Cardiology, Children's Memorial Hospital, Northwestern University Medical School, Chicago, Illinois, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Ringewald
authors.forename: S S
authors.initials: SS
authors.lastname: Gidding
authors.forename: S E
authors.initials: SE
authors.lastname: Crawford
authors.forename: C L
authors.initials: CL
authors.lastname: Backer
authors.forename: C
authors.initials: C
authors.lastname: Mavroudis
authors.forename: E
authors.initials: E
authors.lastname: Pahl
mesh_terms: D000293:Adolescent; D002648:Child; D002851:Chromatography, High Pressure Liquid; D015331:Cohort Studies; D016572:Cyclosporine / Q000097:blood / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology* / Q000401:mortality; D016027:Heart Transplantation / Q000276:immunology* / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood / Q000627:therapeutic use*; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016312:Treatment Refusal
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine