Present address: Behavioral Health Center, Children’s Hospital of Philadelphia, Philadelphia, PA, USA.
Improving adherence to medications in pediatric liver transplant recipients
Article first published online: 15 SEP 2007
Copyright © 2007 Blackwell Munksgaard
Volume 12, Issue 3, pages 316–323, May 2008
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
- Issue published online: 16 JAN 2008
- Article first published online: 15 SEP 2007
- Accepted for pWublication 29 July 2007
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.