Factors that influence nonadherence in immunosuppressant treatment in pediatric transplant recipients: a proposal for an educational strategy.

Kidney transplant is the best treatment for patients with chronic renal failure. Scientific advances have optimized immunosuppressive treatment; however, adherence to medical treatment is not always achieved. Our aims were to identify the key factors that influenced nonadherence behavior to define effective educational strategies. A qualitative study was performed through an analysis of patient/tutor questions in interviews. A quantitative analysis was applied to epidemiologic variables, time posttransplant, and percentages/frequencies of responses from the interviews. A transplant nurse, psychologist, and social worker elaborated an instrument based on seven questions related to the transplant, the risk and/or loss of the graft, events that happened as consequence of this fact, allowing interviewees to freely express their opinions. The interviews were recorded on a microcassette recorder for later transcription. The analysis was determined by categories containing the answers to each question according to frequency. Informed consent was obtained from the parent/tutor. Among 150 transplants performed from 1989 to 2006 there were 15 nonadherences among 80% interviewed subjects. The mean age was 9.7 years. Loss of the graft occurred in 50%, at 37.7 months, post-transplant from 67% deceased and 33% living donors with 25% of cases preemptive transplants. The main factors for nonadherence were lack of supervision in taking medications, numbers and fastidious schedules, family conflicts, and poor communication between parents and the medical team. In conclusion, it is necessary to modify the pattern for transplant patient care that allows the patient and family to actively participate in the medical process including a multidisciplinary group.