Psychological Functioning, Nonadherence and Health Outcomes After Pediatric Liver Transplantation

The present study empirically assessed the relationships between adherence behaviors and HRQOL, parent and child psychological functioning and family functioning, and investigated the relationship between adherence behaviors and health outcomes in children who were within 5 years of their liver tran...

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Bibliographic Details
Published in:American journal of transplantation 2007-08, Vol.7 (8), p.1974-1983
Main Authors: Fredericks, E. M., Lopez, M. J., Magee, J. C., Shieck, V., Opipari‐Arrigan, L.
Format: Article
Language:English
Subjects:
Adherence
Adolescent
Biological and medical sciences
Child
Child Behavior - psychology
Child, Preschool
children
Family Relations
Female
Follow-Up Studies
General aspects
Graft Rejection - prevention & control
Graft Rejection - psychology
Health Status
Humans
Immunosuppressive Agents - therapeutic use
liver transplantation
Liver Transplantation - psychology
Male
Medical sciences
Miscellaneous
Outcome Assessment, Health Care
Public health. Hygiene
Public health. Hygiene-occupational medicine
quality of life
Quality of Life - psychology
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Time Factors
Treatment Refusal
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Summary:The present study empirically assessed the relationships between adherence behaviors and HRQOL, parent and child psychological functioning and family functioning, and investigated the relationship between adherence behaviors and health outcomes in children who were within 5 years of their liver transplantation. Participants included 38 children (mean = 8.5 years, range 28 months to 16 years) and their parent/guardian(s). HRQOL and psychological functioning were examined using well‐validated assessment measures. Measures of adherence included the rate of clinic attendance and standard deviations (SDs) of consecutive tacrolimus blood levels, which were collected and evaluated retrospectively. Measures of child health status included the frequency of hospital admissions, liver biopsies, episodes of rejection and graft function for the year prior to study participation. Results indicated that nonadherence was related to lower physical HRQOL, more limitations in social and school activities related to emotional and behavioral problems, parental emotional distress and decreased family cohesion. Nonadherence was also related to frequency and duration of hospitalizations, liver biopsies and rejection episodes. These results suggest that empirically based assessment of HRQOL, parenting stress and family functioning may help identify patients at risk for nonadherence, and may allow for the need‐based delivery of appropriate clinical interventions. Among children within 5 years of liver transplantation, nonadherence is related to lower health‐related quality of life, increased social and school limitations, parenting stress, decreased family cohesion, and health outcomes such as hospitalization rates, liver biopsies and rejection episodes.
ISSN:1600-6135
1600-6143
DOI:10.1111/j.1600-6143.2007.01878.x