Clinical

Blood levels are only reliable drug compliance measure in pediatric transplant patients

Last Updated: 2004-04-09 15:15:08 -0400 (Reuters Health)

NEW YORK (Reuters Health) - An analysis of immunosuppression adherence among pediatric and adolescent liver transplant recipients shows that the only dependable measures of compliance are blood drug levels, and not the reports of patients, parents, or clinicians.

At the Mount Sinai Medical Center in New York, Dr. Eyal Shemesh and colleagues analyzed data collected in their pediatric liver transplant program's adherence assessment protocol. Adherence was assessed on the basis of questionnaires completed by nurses, physicians, caregivers, and patients. In addition, a standard deviation was calculated for blood levels of tacrolimus over time for each patient. If the standard deviation was high, the patient was assumed to be taking the medication erratically.

Medical outcome measures included rejection episodes, number of biopsies regardless of the results, hospital admissions, and hospital length-of-stays.

Among 81 patients whose transplants had been performed at least 12 months previously, "the only method that predicted the medical outcome variables (biopsy-proven rejection and number of biopsies) was the standard deviation of medication blood levels," the authors write. None of the questionnaire responses were predictive. Furthermore, the clinicians' assessments did not correlate with those of patients or caregivers.

The results are published in the April 2004 issue of Pediatrics.

"The transition of responsibility for medication taking occurred approximately at the age of 12 years," the researchers note. "Forgetfulness was cited as the most common reason for nonadherence by patients and caregivers."

They conclude that "interventions targeting adherence should address the child's increasing role beginning in early adolescence."

Pediatrics 2004;113:825-832.