Paediatric renal transplantation non-compliance

Abstract

The aim of this study was to quantify and where possible objectively confirm the magnitude of non-compliance (NC) in our paediatric renal transplant recipients. A total of 94 paediatric transplants were performed between 1984 and 1989; 17 were excluded due to graft loss (2), death (3), oxalosis (2) and transfer to the adult unit (10). NC was assessed as missed clinic visits plus medication shortages or actual admission of NC. NC was found in 22% (17/77) of transplanted patients. NC showed no correlation with parental marital status, sex, distance lived from the hospital, pre-emptive transplant status or total lymphoid irradiation. Most NC was peripubertal with a smaller NC in the late teenager group. Social class correlated positively with NC; 82.3% of NC was from social classes III and IV, who formed 52.4% of the patients. NC in social class II (3/26) was significantly different from social class IV (12/24) (P = 0.01); 91% of black patients with NC were from social class IV. Race, corrected for social class, failed to reach significance (P > 0.05). Confirmation of compliance was sought from retrospective cyclosporin A (CsA) trough levels (twice daily dosage). Concomitant phenytoin therapy and CsA given as a daily dosage were excluded as significant confounding variables. The CsA dosage was not significantly different between the compliant (C) and patients with NC. Patients with NC were 8 times more likely to have a CsA level < 10 ng/ml (P = 0.0026) than C patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunosuppressant Therapy Adherence and Graft Failure Among Pediatric Renal Transplant Recipients

“…clinicians/transplant centers evaluated this relationship (12,13 (3,5,7,8,10), with some exceptions to this trend (2,11 (14,21,24,32,33). (3,(5)(6)(7)(8)(9)(10)(11)(34)(35)(36).…”

“…(3,(5)(6)(7)(8)(9)(10)(11)(34)(35)(36). Therefore, the belief that adolescents are more nonadherent compared to children should be further examined.…”

“…The impact of IST nonadherence on graft outcomes among pediatric RTRs has been assessed, with studies finding IST nonadherence associated with graft failure (3,(5)(6)(7)(8)(9)(10)(11). However, the generalizability of these findings is potentially limited due to the lack of samples from multicenter trials evaluating nonadherence (3,(5)(6)(7)(8)(9)(10)(11). (12,13).…”

Cumplimiento del tratamiento en el trasplante renal pediátrico

“…En general, los pacientes pediátricos y los adolescentes tienen peor adherencia al tratamiento comparándolos con la edad adulta. Esto se asocia a un aumento de pérdida del injerto 4 …”

Associations with medication adherence among ethnically different pediatric patients with renal transplants

“…Reported rates of medication nonadherence among pediatric patients range from 5% to greater than 50% [6][7][8][9]. The consequences of medication nonadherence in renal transplant patients (both pediatric and adult patients) include enormous financial, physical, and psychological costs, loss of allograft, increased hospitalizations, and even death [5,[10][11][12]. Factors influencing medication adherence among renal transplant patients that have been examined include the following: (1) cosmetic side effects of transplantation [9,13,14]; (2) gender [15][16][17];…”