Blood Test Best Way to Monitor Kids with Transplants

The results of an analysis that examined the adherence to immunosuppressive drugs by children and adolescents who have received liver transplants show that measuring drug levels in the blood is the only dependable way to determine compliance–not relying on the reports of patients, parents or doctors.

The results of an analysis that examined the adherence to immunosuppressive drugs by children and adolescents who have received liver transplants show that measuring drug levels in the blood is the only dependable way to determine compliance–not relying on the reports of patients, parents or doctors. At the Mount Sinai Medical Center in New York, Dr. Eyal Shemesh and colleagues analyzed data collected in their pediatric liver transplant program’s adherence assessment protocol. Adherence was assessed on the basis of questionnaires completed by nurses, physicians, caregivers, and patients. In addition, blood levels of the immunosuppressive drug tacrolimus were calculated over time for each patient. If the range of drug levels was high, the patient was assumed to be taking the medication erratically. Medical outcome measures included rejection episodes, the number of biopsies that need to be performed regardless of the results, hospital admissions, and hospital length-of-stays. Among 81 patients whose transplants had been performed at least 12 months previously, the only method that predicted the medical outcomes, which included biopsy-proven organ rejection and number of biopsies, was the level of medication in the blood, the authors report in the journal Pediatrics. None of the questionnaire responses reliably correlated with medical outcomes. Furthermore, the physicians’ assessments did not correlate with those of patients or caregivers. “The transition of responsibility for medication taking occurred approximately at the age of 12 years,” the researchers note. “Forgetfulness was cited as the most common reason for nonadherence by patients and caregivers.” They conclude that “interventions targeting adherence should address the child’s increasing role beginning in early adolescence.” (Source: Pediatrics: Reuters Health: Medline Plus: April 2004.)