Berquist Rebecca K, Berquist William E, Esquivel Carlos O, Cox Kenneth L, Wayman Karen I, Litt Iris F
Department of Pediatrics, Stanford University Medical School, Palo Alto, CA 94304, USA.
Pediatr Transplant. 2008 Mar;12(2):194-200. doi: 10.1111/j.1399-3046.2007.00809.x.
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.
本研究调查了青少年肝移植受者中与不坚持移植后护理相关的患病率、人口统计学变量及不良后果。我们对111例移植后超过6个月的青少年患者（年龄12 - 21岁）进行了回顾性病历审查，并将2005年不坚持定义为未服用免疫抑制剂或未进行任何门诊就诊。50名受试者（45.0%）不坚持，61名（55.0%）坚持。20%的受试者未进行门诊就诊，10.9%未完成实验室检查。单因素和多因素分析均显示，不坚持与完成的实验室检查较少显著相关（p < 0.0001）、单亲状态（p < 0.0186）、年龄较大及移植后时间较长相关（分别为p < 0.008、p < 0.0141和p < 0.0012、p < 0.0174）。31例患者中，不坚持服药与排斥反应显著相关（p < 0.0069），但在7例完全停用免疫抑制剂的亚组患者中并非如此。不坚持移植后护理在青少年中是一个普遍问题，尤其是年龄较大及移植后时间较长者。除了在一个假定具有移植物耐受性且停用免疫抑制剂的亚组中，排斥反应是不坚持服药的一个重要后果。这些结果强调了严格监测移植后护理依从性对于提高青少年移植患者长期生存率和生活质量的必要性。
