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Patient Compliance Influences Pediatric Transplant Recommendations

BETHESDA, MD -- January 7, 2003 -- Whether or not a doctor recommends a child for kidney transplantation often depends on the child's track record for sticking to a medication regimen, researchers at the Johns Hopkins Children's Center report.

According to a study published in the January issue of the American Journal of Transplantation, 94 percent of pediatric patients described as "compliant" with medication regimens for their kidney disease were recommended by physicians for transplant, compared to 62 percent who were labeled "not compliant."

Because organ rejection is the most serious complication following transplant, patient compliance with an anti-rejection medication regimen is critical, the researchers say, and may explain why physicians were strongly influenced by reports of the patient's prior history of compliance.

Lead author Susan L. Furth, M.D., Ph.D., a pediatric nephrologist at the Children's Center, cautions, however, that while physicians may assume non-compliance plays a role in rejection, they cannot know for certain who will actually be compliant after the transplant.

"Any physician or family concerns about ability to comply with post-transplant treatment regimens should be discussed openly to overcome potential barriers to kidney transplantation," she said.

For their study, the Johns Hopkins researchers surveyed a random sample of 316 pediatric and adult nephrologists from across the country. Each physician was presented with 10 hypothetical case scenarios of children and adolescents with kidney failure, including information on the patient's age, race, number of parents in the home, parents' educational level, and compliance history. Physicians were asked whether or not they would recommend transplantation.

Researchers also found the education level of the child's parents influenced transplantation recommendations. Children of more educated parents were more likely to be referred for transplantation, with 83 percent whose parents had some college education recommended, compared to 77 percent whose parents did not complete high school. Physicians may believe that more educated parents may better understand the importance of post-transplant medication compliance, and help their children with it, Furth says.

Overall, transplantation was recommended in 80 percent of the cases that were presented. There were no differences in transplant recommendations associated with patient age, race, sex, cause of end-stage renal disease, or the number of parents in the home.

"Our study suggests that physicians and families of all potential kidney transplant recipients should actively explore the option of transplantation, regardless of education, race, or compliance history," said Furth.

Children's Center pediatric nephrologists Barbara A. Fivush, M.D., Alicia M. Neu, M.D., and researchers from the Welch Center for Prevention, Epidemiology and Clinical Research and the Departments of Health Policy and Management, Epidemiology, and Medicine at Johns Hopkins contributed to this study. The study was supported by grants from the National Institutes of Diabetes and Digestive and Kidney Diseases.


SOURCE: Johns Hopkins

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