title: Improving adherence to medications in pediatric liver transplant recipients.
abstract: We describe results from a clinical program, which aimed at improving adherence to medications in children who had a liver transplant. We followed the medical outcomes of 23 children and adolescents who participated in a clinical adherence-improvement protocol during the years 2001-2002. The protocol included identification of non-adherent patients by examining tacrolimus blood levels and intervention by increasing the frequency of clinic visits for non-adherent patients. In the two-yr preintervention (1999-2000), there was no improvement in any of the outcomes. After the intervention, the number of patients with high alanine aminotransferase levels (100 and above) decreased significantly, from eight before the intervention to four afterwards. Other outcomes, including the number of rejection episodes (three before, none after) and the degree of adherence to tacrolimus, also improved, but the improvement did not reach statistical significance. Although non-adherent patients were called to clinic more often under the protocol, the intervention did not lead to increased outpatient costs. This adherence--improvement intervention appears to be promising in improving outcomes in pediatric liver transplant recipients. Larger, controlled studies are needed to establish the efficacy of this or other approaches.
authors.affiliation: Department of Psychiatry, Mount Sinai Medical Center, New York, NY, USA. Shemesh@email.chop.edu
authors.forename: E
authors.initials: E
authors.lastname: Shemesh
authors.forename: R A
authors.initials: RA
authors.lastname: Annunziato
authors.forename: B L
authors.initials: BL
authors.lastname: Shneider
authors.forename: C A
authors.initials: CA
authors.lastname: Dugan
authors.forename: J
authors.initials: J
authors.lastname: Warshaw
authors.forename: N
authors.initials: N
authors.lastname: Kerkar
authors.forename: S
authors.initials: S
authors.lastname: Emre
mesh_terms: D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000378:metabolism; D002648:Child; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood / Q000627:therapeutic use; D016031:Liver Transplantation / Q000191:economics / Q000379:methods*; D008297:Male; D010349:Patient Compliance; D010372:Pediatrics / Q000379:methods; D012646:Self Administration; D016559:Tacrolimus / Q000097:blood / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D000410:Alanine Transaminase; D016559:Tacrolimus