Non‐adherence in pediatric liver transplant recipients − an assessment of risk factors and natural history

Pediatric Transplantation - Tập 4 Số 3 - Trang 200-206 - 2000
Susan Lurie1, Eyal Shemesh1,2, Patricia A. Sheiner3,4, Sukru Emre3,4, Helen L. Tindle1, Libera Melchionna5, Benjamin L. Shneider2,4
1Departments of Psychiatry
2Pediatrics
3Surgery and
4The Recanati/Miller, Transplantation Institute, Mount Sinai School of Medicine, New York, New York, USA
5Social Work, and

Tóm tắt

Abstract: Despite the fact that non‐adherence to medical therapy is one of the major causes of late morbidity and mortality in pediatric liver transplant recipients, little is known of the risk factors involved in this behavior. Three cases of fatal non‐adherence are reported. Factors associated with non‐adherence were investigated by performing a retrospective chart review of a panel of 27 variables in an age‐matched cohort of 15 pediatric liver transplant recipients. The most striking differences between the severely non‐adherent group and the age‐matched cohort included history of substance abuse, child abuse (physical or sexual), not having two parents at home, having received public assistance, having been diagnosed with a psychiatric disorder, and history of school dropout. In addition it appeared that a pretransplant diagnosis of autoimmune hepatitis was associated with more significant medical sequelae related to non‐adherence. These findings are preliminary owing to the retrospective design of this study, but could be used as a starting point for a prospective study of this important phenomenon.

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Tài liệu tham khảo

Cramer JA, 1991, Patient Compliance in Medical Practice and Clinical Trials

10.1097/00007890-199002000-00029

10.1016/S0041-1345(98)01682-0

10.1016/S0031-3955(05)70459-4

10.1097/00004703-198908000-00010

Coons SJ, 1994, Predictors of medication noncompliance in a sample of older adults, Clin Ther, 16, 110

Lerman C, 1994, Younger women at increased risk for breast cancer: perceived risk, psychological well‐being and surveillance behavior, J Natl Cancer Inst Monogr, 16, 171

ShemeshE LurieS StuberM et al.A pilot study of posttraumatic stress and nonadherence in pediatric liver transplant recipients.Pediatrics2000:105: e29.

10.1097/00005650-198206000-00007

10.2337/diacare.15.11.1658

10.1016/0306-4603(95)00058-5

10.3109/10826089809056256

10.1016/S0740-5472(98)00014-2

10.1016/S1054-139X(98)00111-6

10.1097/00004583-199706000-00017

10.1023/A:1021900423004

Widom CS, 1999, Posttraumatic stress disorder in abused and neglected children grown up, Am J Psychiatry, 156, 1223, 10.1176/ajp.156.8.1223

10.1016/S0002-9343(96)00402-0

Dew MA, 1996, Medical compliance and its predictors in the first year after heart transplantation, J Heart Lung Transplant, 15, 631

10.1016/S0022-3476(80)80653-6

Korsch BM, 1978, Nonadherence in children with renal transplants, Pediatrics, 61, 872, 10.1542/peds.61.6.872

McDermott MM, 1997, Impact of medication nonadherence on coronary heart disease outcomes, Arch Intern Med, 157, 1921, 10.1001/archinte.1997.00440380023002

10.1097/00007890-199560120-00016

10.1037/h0089303