Citation

Shemesh E, Annunziato RA, Yehuda R, Shneider BL, Newcorn JH, Hutson C, Cohen JA, Briere J, Gorman JM, Emre S. J. Am. Acad. Child Adolesc. Psychiatry 2007; 46(10): 1280-1289.

Affiliation

ol of Medicine, University of Southern California, Los Angeles.

Copyright

(Copyright © 2007, American Academy of Child Adolescent Psychiatry, Publisher Lippincott Williams and Wilkins)

DOI

10.1097/chi.0b013e3180f62aff

PMID

17885569

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.

Language: en