Childhood Abuse, Nonadherence, and Medical Outcome in Pediatric Liver Transplant Recipients

ABSTRACTObjectiveThe study assessed the relationship between a history of child abuse, nonadherence to medications, and medical outcome in children who had a liver transplant.MethodAbuse 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.ResultsOf 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.ConclusionsA 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.