Noncompliance in Children and Adolescents After Renal Transplantation

Abstract

This study assesses the perceptions, knowledge, and attitudes of patients and parents attending the Pediatric Transplant Unit at the Johannesburg Hospital. Fifty-six children with renal transplants accompanied by their parents were assessed by means of a questionnaire. The children's ages were 2.53 to 20.85 years. Eleven of twelve in the noncompliant group were male and nine were Black. The ages of the two groups of patients and distance traveled to the transplant center were similar. The noncompliant group of patients more often missed clinic visits (50% vs. 14%), P=0.0201; forgot to take their medications (50% vs. 23%); and took more medications (10.3 +/- 3.0 vs. 7.5 +/- 2.0) and remembered fewer of their names (4.0 +/- 3.5 vs. 6.5 +/- 2.5), P=0.0001 than the compliant group. The noncompliant patients knew less about their disease (50% vs. 8.3%) P=0.0141, allograft (53% vs. 33%), and immunosuppression (66% vs. 200%) P=0.0217, than the compliant patients. A total of 9% of the patients (5/56) were concerned about immunosuppressive side-effects, and indicated that this affected their compliance. Families wanted additional information, both pretransplant (52%) and posttransplant (45.5%). In addition, 85% wanted ongoing in-house education concerning transplantation and medications. Pediatric renal transplant patients and their families require ongoing education, support, medication evaluation, and compliance surveillance. Patients at high risk of noncompliance require directed additional intervention.

Psychological Distress and Adherence to the Medical Regimen Among Adolescent Renal Transplant Recipients

“…Consistent with other studies in the child and adolescent population, we found evidence of nonadherence in our subjects at both interviews (11)(12)(13)(14). Several studies have examined nonadherence with medications among children and adolescents and report widely varying rates, ranging from 18% to 69% (8)(9)(10)13,14,71). Although differences in methodologies employed to assess medication nonadherence makes meaningful comparisons difficult, our rates of 13.6% at each of the two interviews appear to be less than the lower end of this range.…”

“…Although differences in methodologies employed to assess medication nonadherence makes meaningful comparisons difficult, our rates of 13.6% at each of the two interviews appear to be less than the lower end of this range. Only one study specifically examined missed clinic visits and found that 29% of the total sample of children and adolescents did not attend clinic regularly (10). In comparison, our rate of 50% at the first interview was higher, and 31.8% at the second interview was about the same.…”

“…Among the leading causes of graft loss is nonadherence with the post-transplant treatment regimen (4)(5)(6), accounting for as much as 78% of graft loss (7). Studies that include children and adolescents indicate that adolescents are at greater risk than younger children for nonadherence, with rates as high as 64% (8)(9)(10)(11)(12)(13)(14).…”

The management of childhood liver diseases in adulthood

“…Key risk factors include lower socioeconomic status, passive parent involvement, side-effects related to medications and poor communication with health care teams [27,[30][31][32][33][34].…”

The New Normal: A Bourdieusian Examination of Living Into Young Adulthood Being a Paediatric Heart Transplant Recipient

“…Additionally, the healthcare team monitors for side effects of medications, which can frequently lead to facial swelling, acne, and weight gain. Often, female adolescent transplant recipients cite cosmetic reasons for discontinuing their medication (Meyers, Thomson, & Weiland, 1996). Studies have suggested that children who received a vital organ transplant have more behavioural problems and less social competence than healthy peers (Uzar et al, 1992).…”