小児肝移植における免疫抑制剤の管理状況～よりよい自己管理を目指して～

抄録

【Background/Aim】Adherence to immunosuppressive medication among liver transplant recipients is crucial for patient outcome. The parents are greatly involved in the management of immunosuppressants for children, which is different from that for adults. We performed a questionnaire survey to assess the factors related to adherence toward immunosuppressive medication among pediatric patients; the questionnaire sought responses to "I nursed it" and "how I should intervene?"
【Patients and methods】From January 1994 to December 2010, nineteen live-donor liver transplants (recipients younger than 15) were performed in our institute.
【Results】One patient was excluded because the patient is immunosuppression-free. The questionnaire response rate was 88.9% (16 of 18 responses generated). The median age of the transplant recipients and questionnaire survey participants was 5.5 years and 11 years. Self-adherence to immunosuppressive medication was observed in 6 recipients (38%), and parent-monitored adherence was observed in 10 (62%) recipients. The frequency of nonadherence was observed as follows: no instances of missed dose; 4 patients rarely missed dose; 7 patients occasionally missed dose; 2 patients intermittently missed dose; 3 patients. The most common reason for nonadherence was "forgot."
【Conclusion】The importance of immunosuppressive medication should be continually informed to pediatric recipients and their parents to create the awareness to adherence. About the time to begin self-control of an oral medicine, recipients and their parents are in the state of groping and considered to be worth showing an indicator by intervention of nursing.