Miloh Tamir, Annunziato Rachel, Arnon Ronen, Warshaw Jill, Parkar Sanobar, Suchy Frederick J, Iyer Kishore, Kerkar Nanda
Department of Pediatrics, Recanati Miller Transplant Institute, Mount Sinai Hospital, New York, New York 10029, USA.
Pediatrics. 2009 Nov;124(5):e844-50. doi: 10.1542/peds.2009-0415. Epub 2009 Oct 12.
The goal was to improve immunosuppressant adherence for pediatric patients with orthotopic liver transplants by using text messaging (TM).
A prospective study of sending TM reminders to the primary medication administrator (patient or caregiver) for pediatric transplant recipients was performed. Patient records were reviewed, comparing the year before and the year of the study. The SD of serum tacrolimus levels was used as an indicator of adherence.
Forty-one patients provided consent. The median age was 15 years (range: 1-27 years), and the median age at the time of transplantation was 2 years (range: 4 months to 23 years). Fourteen patients (34%) were male. In 29 of 41 cases, the medications were self-administered by the patient. The mean duration of study was 13 +/- 1.5 months. Twenty-two patients were receiving 1 immunosuppressant, 14 were receiving 2, and 5 were receiving 3. Thirteen patients (37%) stopped the study after 4 months. The mean tacrolimus level SD decreased from 3.46 microg/L before the study to 1.37 microg/L (P < .005). The number of immunosuppressants taken and patient self/caregiver medication administration did not significantly affect the results. The number of acute cellular rejection episodes decreased from 12 to 2 during the study. Risk factors for rejection were older age (17.67 vs 13.28 years) and administration of >1 immunosuppressant.
We observed significant improvement in medication adherence and a reduction in rejection episodes with TM reminders for pediatric recipients of liver transplants.
通过使用短信（TM）提高原位肝移植儿科患者的免疫抑制剂依从性。
对儿科移植受者的主要药物管理者（患者或护理人员）发送TM提醒进行前瞻性研究。回顾患者记录，比较研究前一年和研究当年的情况。血清他克莫司水平的标准差用作依从性指标。
41名患者提供了同意。中位年龄为15岁（范围：1 - 27岁），移植时的中位年龄为2岁（范围：4个月至23岁）。14名患者（34%）为男性。41例中有29例患者自行给药。研究的平均持续时间为13±1.5个月。22名患者接受1种免疫抑制剂，14名接受2种，5名接受3种。13名患者（37%）在4个月后停止研究。他克莫司水平的平均标准差从研究前的3.46μg/L降至1.37μg/L（P <.005）。服用的免疫抑制剂数量以及患者自行/护理人员给药情况对结果无显著影响。研究期间急性细胞排斥反应发作次数从12次降至2次。排斥反应的风险因素为年龄较大（17.67岁对13.28岁）以及使用>1种免疫抑制剂。
我们观察到，对于肝移植儿科受者，TM提醒显著提高了药物依从性并减少了排斥反应发作次数。
