title: Non-adherence to post-transplant care: prevalence, risk factors and outcomes in adolescent liver transplant recipients.
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.
authors.affiliation: Department of Pediatrics, Stanford University Medical School, Palo Alto, CA 94304, USA. rebecca.berquist@stanford.edu
authors.forename: Rebecca K
authors.initials: RK
authors.lastname: Berquist
authors.forename: William E
authors.initials: WE
authors.lastname: Berquist
authors.forename: Carlos O
authors.initials: CO
authors.lastname: Esquivel
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Cox
authors.forename: Karen I
authors.initials: KI
authors.lastname: Wayman
authors.forename: Iris F
authors.initials: IF
authors.lastname: Litt
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D016312:Treatment Refusal / Q000706:statistics & numerical data*