Childhood abuse, nonadherence, and medical outcome in pediatric liver transplant recipients

J Am Acad Child Adolesc Psychiatry. 2007 Oct;46(10):1280-1289. doi: 10.1097/chi.0b013e3180f62aff.

Abstract

Objective: The study assessed the relationship between a history of child abuse, nonadherence to medications, and medical outcome in children who had a liver transplant.

Method: Abuse history for children and adolescents ages 8 to 21 who underwent a liver transplantation at Mount Sinai Medical Center in New York was obtained in interviews in 2002. Adherence to tacrolimus was assessed from January 1 to December 31, 2003 by computing the SD of a series of medication blood levels for each patient. Biopsy-proven rejection episodes, degree of fluctuation of alanine aminotransferase (ALT), and maximal ALT levels were recorded as indicators of medical outcome.

Results: Of 72 eligible patients, 56 were evaluated. Five had documented abuse. Abused children were less adherent to their medication regimen (p = .02; 95% confidence interval [CI] -2.66 to -0.24), had poor disease control (higher maximal ALT, p <.01; 95% CI -613.72 to -249.55), had greater fluctuation in ALT levels (p <.01; 95% CI -151.19 to -65.91), and suffered more biopsy-proven rejection episodes (two episodes in the abused cohort versus none in the rest) in 2003.

Conclusions: A history of child abuse is a significant risk factor for poor outcome posttransplantation and should be evaluated routinely. Adherence to medications can be a target for intervention in patients with a history of abuse.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Alanine Transaminase / metabolism
  • Child
  • Child Abuse / psychology
  • Child Abuse / statistics & numerical data*
  • Female
  • Graft Rejection / diagnosis
  • Graft Rejection / enzymology
  • Graft Rejection / epidemiology*
  • Humans
  • Liver Transplantation*
  • Male
  • Treatment Outcome
  • Treatment Refusal / statistics & numerical data*

Substances

  • Alanine Transaminase