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

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Pediatric Transplantation

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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

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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, USA

1Department 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, USATel.: Fax: E-mail: emfred@...CHQ, Child Health Questionnaire; CHQ-CF, Child Health Questionnaire, Child Form; CHQ-PF, Child Health Questionnaire, Parent Form; HRQOL, health-related quality of life; LT, liver transplant; MAM, Medication Adherence Measure; MEMS, Medication Event Monitoring System; OTIS, Organ Transplant Information System; PedsQL, Pediatric Quality of Life Inventory; s.d., standard deviation. Fredericks EM, Magee JC, Opipari-Arrigan L, Shieck V, Well A, MJ. Adherence and health-related quality of life in adolescent liver transplant recipients. Pediatr Transplantation 2008: 00: 000–000. © 2008 Blackwell Munksgaard

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.