Copyright @ 2007 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited. Childhood Abuse, Nonadherence, and Medical Outcome in Pediatric Liver Transplant Recipients

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] j2.66 to j0.24), had poor disease control (higher maximal ALT, p <.01; 95 % CI j613.72 to j249.55), had greater fluctuation in ALT levels (p <.01; 95 % CI j151.19 to j65.91), 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. J. Am. Acad. Child Adolesc. Psychiatry, 2007;46(10):1280Y1289. Key Words: nonadherence, abuse, domestic violence, liver transplant. Psychosocial evaluations are an integral part of the routine pretransplantation evaluation procedure for solid organ transplant recipients (Dew et al., 2000; European Exper