Evaluating non-adherence to immunosuppressant medications in pediatric liver transplant recipients.

TitleEvaluating non-adherence to immunosuppressant medications in pediatric liver transplant recipients.
Publication TypeJournal Article
Year of Publication2008
AuthorsStuber, ML, Shemesh E, Seacord D, Washington J, Hellemann G, McDiarmid S
JournalPediatric transplantation
Volume12
Issue3
Pagination284-8
Date Published2008 May
ISSN1399-3046
KeywordsAdolescent, Child, Child, Preschool, Female, Graft Rejection, Humans, Immunosuppressive Agents, Infant, Infant, Newborn, Liver Transplantation, Male, Patient Compliance, Pediatrics, Retrospective Studies, Tacrolimus
Abstract

Non-adherence with recommended immunosuppressant medications is common post-pediatric liver transplant and is the most important reason for organ rejection in long-term survivors. However, there is currently no validated, standard method to measure adherence, with a well-defined threshold, making it extremely difficult to evaluate interventions to improve adherence. Previous studies have suggested that the degree of fluctuation of medication blood levels over time can provide an idea about how regularly the medication is being taken. The present study, conducted at UCLA medical center, sought to identify a specific threshold value of the s.d. of individual tacrolimus blood levels in pediatric liver transplant recipients which would be associated with rejection episodes in these patients. A threshold of 3.0 has been identified in other studies, and was supported by the analysis of retrospective data from 96 subjects. However, further analysis found that a s.d. of 2.5 appeared to have a better fit with the data. These findings suggest the utility of monitoring the s.d. of routine tacrolimus blood levels in pediatric liver transplant recipients for detecting non-adherence to immunosuppressant medication prior to clinical rejection, allowing earlier interventions.

DOI10.1111/j.1469-8986.2012.01383.x
Alternate JournalPediatr Transplant