Adherence and health-related quality of life in adolescent liver transplant recipients

February 18, 2008

Pediatric Transplantation

Volume 0 Issue 0 Page ???,

To cite this article: M. Fredericks, C. Magee, Opipari-Arrigan,

Shieck, Well, M. (2008)

Adherence and health-related quality of life in adolescent liver transplant

recipients

doi:10.1111/j.1399-3046.2008.00901.x

Abstract

Adherence and health-related quality of life in adolescent liver transplant

recipients

M. Fredericks11Department of Pediatrics, University of Michigan Medical

School, Ann Arbor, MI, USA, C. Magee22Department of Surgery, University of

Michigan Medical School, Ann Arbor, MI, USA, Opipari-Arrigan33Behavioral

Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center,

Cincinnati, OH, USA, Shieck44Transplant Center, University of Michigan

Medical School, Ann Arbor, MI, USA, Well11Department of Pediatrics,

University of Michigan Medical School, Ann Arbor, MI, USA and M.

11Department of Pediatrics, University of Michigan Medical School, Ann

Arbor, MI, USA1Department of Pediatrics, University of Michigan Medical School,

Ann Arbor, MI, USA, 2Department of Surgery, University of Michigan Medical

School, Ann Arbor, MI, USA, 3Behavioral Medicine & Clinical Psychology,

Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA, 4Transplant

Center, University of Michigan Medical School, Ann Arbor, MI, USA

M. Fredericks, PhD, 1924 Taubman Center, SPC 5318, 1500 E. Medical Center

Drive, Ann Arbor, MI 48109-5318, USA

Tel.: 734 615 3866

Fax: 734 936 6897

E-mail: emfred@...

Abstract

Abstract: Adolescence is a particularly high-risk period for non-adherence with

post-transplant medical regimens. There remains a lack of research investigating

factors related to non-adherence in adolescent LT recipients. The present study

empirically assessed the relationship between adherence and HRQOL in adolescent

LT recipients. Participants included 25 adolescents (mean = 15.1 yr, range

12–17.9) and their parent/guardian(s). Adherence was assessed using multiple

indices including clinician-conducted interviews, rate of clinic attendance, and

s.d. of consecutive tacrolimus blood levels. HRQOL was examined using

self-report and parent-proxy report on well-validated assessment measures.

Results indicated that 76% of participants were non-adherent on at least one

measure of adherence, and HRQOL was significantly lower than normative data for

healthy children. Tacrolimus s.d. were significant related to poor HRQOL across

domains of physical, school, and social functioning. Non-adherent adolescents

reported poorer health perceptions, self-esteem, mental health, family cohesion,

and more limitations in social and school activities related to physical,

emotional, and behavioral problems. These results suggest that empirically based

assessment of HRQOL may help identify those at highest risk for behavior,

emotional and school difficulties, as well as non-adherence. The examination of

tacrolimus s.d. may also help identify patients who may benefit from

intervention to promote adherence and HRQOL. Prospective investigations are

necessary to further identify the impact of HRQOL on adherence and long-term

health outcomes to further guide clinical intervention.

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1399-3046.2008.00901.x

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February 18, 2008