Improving adherence to medications in pediatric liver transplant recipients

  1. E. Shemesh1,2,3,†,
  2. R. A. Annunziato1,
  3. B. L. Shneider2,3,‡,
  4. C. A. Dugan3,
  5. J. Warshaw3,
  6. N. Kerkar2,3,
  7. S. Emre2,3,§

Article first published online: 15 SEP 2007

DOI: 10.1111/j.1399-3046.2007.00791.x

Issue

Pediatric Transplantation

Pediatric Transplantation

Volume 12, Issue 3, pages 316–323, May 2008

Additional Information

How to Cite

Shemesh, E., Annunziato, R. A., Shneider, B. L., Dugan, C. A., Warshaw, J., Kerkar, N. and Emre, S. (2008), Improving adherence to medications in pediatric liver transplant recipients. Pediatric Transplantation, 12: 316–323. doi: 10.1111/j.1399-3046.2007.00791.x

Author Information

  1. 1

    Departments of Psychiatry

  2. 2

    Pediatrics

  3. 3

    Recanati-Miller Transplant Institute, Mount Sinai Medical Center, New York, NY, USA

  1. †

    Present address: Behavioral Health Center, Children’s Hospital of Philadelphia, Philadelphia, PA, USA.

  2. ‡

    Present address: Division of Pediatric Gastroenterology, Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA.

  3. §

    Present address: Yale University Medical Center in New Haven, New Haven, CT, USA.

*Eyal Shemesh, Director, Behavioral Health Integrated Program, Department of Child and Adolescent Psychiatry and The Behavioral Health Center, The Children’s Hospital of Philadelphia, 3440 Market Street – Suite 410, Philadelphia, PA 19104, USA Tel.: +1 215 590 1398 Fax: +1 215 590 4251 E-mail: Shemesh@email.chop.edu

Publication History

  1. Issue published online: 16 JAN 2008
  2. Article first published online: 15 SEP 2007
  3. Accepted for pWublication 29 July 2007

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Keywords:

  • compliance;
  • tacrolimus;
  • intervention

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.

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