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Non‐adherence to post‐transplant care: Prevalence, risk factors and outcomes in adolescent liver transplant recipients

Abstract:  This study examined the prevalence, demographic variables and adverse outcomes associated with non‐adherence to post‐transplant care in adolescent liver transplant recipients. We conducted a retrospective chart review of 111 adolescent patients (age 12–21 yr) greater than six months post‐transplantation and defined non‐adherence as not taking the immunosuppressive(s) or not attending any clinic visit in 2005. Fifty subjects (45.0%) were non‐adherent and 61 (55.0%) were adherent. Twenty percent of the subjects did not attend clinic and 10.9% did not complete laboratory tests. Non‐adherence was significantly associated with fewer completed laboratory tests (p < 0.0001), single parent status (p < 0.0186), and older age and greater years post‐transplantation by both univariate and multivariate analyses (p < 0.008, p < 0.0141 and p < 0.0012, p < 0.0174, respectively). Non‐adherence to medication was significantly associated with a rejection episode in 31 patients (p < 0.0069) but not in the subgroup of seven patients who stopped their immunosuppression completely. Non‐adherence to post‐transplant care is a prevalent problem in adolescents particularly of an older age and greater years post‐transplantation. Rejection was a significant consequence of medication non‐adherence except in a subgroup with presumed graft tolerance who discontinued their immunosuppression. These results emphasize the need for strict monitoring of adherence to post‐transplant care to improve long‐term survival and quality of life in adolescent transplant patients.