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Medical adherence in pediatric organ transplantation: what are the next steps?

Shellmer, Diana A.a; Dabbs, Annette DeVitob; Dew, Mary Amandac

Current Opinion in Organ Transplantation: October 2011 - Volume 16 - Issue 5 - p 509–514
doi: 10.1097/MOT.0b013e32834a8c89
Pediatric transplantation: Edited by George V. Mazariegos

Purpose of review Adherence within pediatric transplantation has gained importance as the complexities of long-term medical management of these patients are identified and knowledge regarding the negative consequences of nonadherence accumulates. We review recent findings to highlight gaps in the literature and make suggestions for future directions.

Recent findings Most research has focused on medication nonadherence, and a recent meta-analysis indicates that nonadherence is more prevalent in adolescent transplant recipients than in younger children. Nonadherence to other areas of the regimen (e.g. clinic attendance) may be even more common than medication nonadherence. However, work to date is based primarily on kidney and liver pediatric transplant patients, with a paucity of research on heart, lung and intestinal recipients. Risk factors for nonadherence after pediatric transplantation include poor family and child functioning. Intervention research remains rare. Challenges include the need for clearer definitions of what constitutes clinically significant nonadherence, longitudinal and prospective assessment of a wider range of potential risk factors, and the development and evaluation of interventions to treat or prevent nonadherence.

Summary Adherence research in pediatric transplantation is in its infancy. Significant opportunities exist to advance the field and create standards for effective identification, measurement, and treatment of nonadherence.

aDepartment of Pediatric Transplant Surgery, School of Medicine University of Pittsburgh, The Children's Hospital of Pittsburgh

bDepartment of Acute and Tertiary Care School of Nursing

cDepartments of Psychiatry, Psychology, Epidemiology and Biostatistics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

Correspondence to Diana A. Shellmer, PhD, Children's Hospital of Pittsburgh, One Children's Hospital Drive, 4401 Penn Avenue, Faculty Pavilion Floor 6, Pittsburgh, PA 15224, USATel: +1 412 692 6110; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.