Adolescence, liver transplantation and medication adherence

Abstract

The biological, psychological and social developmental changes that occur during the adolescence place the transplanted adolescent at higher risk of non-adherence and poor outcome than other age groups. Purpose: This study tries to assess the importance of age- related behavioral factors in the patient outcome after liver transplantation. Patients and Methods: Seven instruments were applied to 30 liver transplanted adolescents and young adults (12-30 years old): life satisfaction scale, life orientation scale, resilience scale, self-esteem scale, perceived general self-efficacy scale, exigency and responsiveness scale and quality of familiar interaction scale. Results: In multivariate logistic regression, the variables of life orientation and resilience influence groups with and without clinical rejection (p=0,03). Father’s variables that increased adherence were negative communication, responsiveness, positive marital climate, physical punishment and positive communication (p=0.03), while involvement, feelings of the children and positive communication increased clinical rejection (p<0,01). For the mother, requirement, positive communication and physical punishment were associated to adherence (p=0,06). Physical punishment and negative communication increase clinical rejection (p=0.02). Conclusions: The psychological profile of the patient and family influence adherence to immunosuppression and rejection after liver transplantation and could be used to screen patients at risk for poor adherence to immunosuppression and subsequent graft rejection.