Noncompliance in Children With Renal Transplants

Abstract

Fourteen patients (13 of them adolescents) interrupted immunosuppressive treatment following renal transplantation. Twelve were girls and two were boys. Six subsequently lost their allografts and eight had impaired renal function. Noncompliance was suspected when diminution in cushingoid features, unexplained weight loss, or changes in renal function occurred. Noncompliance was confirmed by interview with psychosocial staff. Available psychosocial data from family interview and personality tests obtained earlier as part of systematic followup study were analyzed to explore the reasons for noncompliance. Noncompliant patient families had lower incomes, more fatherless households, and communication difficulties within the family and with the medical establishment. Using a stepwise discriminant analysis, a discriminant function was derived which selected 13 of 14 noncompliant patients. Noncompliance may be a preventable cause of allograft failure. These data can aid in identifying high-risk patients and planning intervention programs.