PEDIATRIC RENAL-TRANSPLANTATION NONCOMPLIANCE

The aim of this study was to quantify and where possible objectively c onfirm the magnitude of non-compliance (NC) in our paediatric renal tr ansplant recipients. A total of 94 paediatric transplants were perform ed between 1984 and 1989; 17 were excluded due to graft loss (2), deat h (3), oxalosis (2) and transfer to the adult unit (10). NC was assess ed as missed clinic visits plus medication shortages or actual admissi on of NC. NC was found in 22% (17/77) of transplanted patients. NC sho wed no correlation with parental marital status, sex, distance lived f rom the hospital, pre-emptive transplant status or total lymphoid irra diation. Most NC was peripubertal with a smaller NC in the late teenag er group. Social class correlated positively with NC; 82.3% of NC was from social classes III and IV, who formed 52.4% of the patients. NC i n social class II (3/26) was significantly different from social class IV (12/24) (P = 0.01); 91% of black patients with NC were from social class IV. Race, corrected for social class, failed to reach significa nce (P > 0.05). Confirmation of compliance was sought from retrospecti ve cyclosporin A (CsA) trough levels (twice daily dosage). Concomitant phenytoin therapy and CsA given as a daily dosage were excluded as si gnificant confounding variables. The CsA dosage was not significantly different between the compliant (C) and patients with NC. Patients wit h NC were 8 times more likely to have a CsA level < 10 ng/ml (P = 0.00 26) than C patients. Patients with NC have needed more grafts (P = 0.0 37), have a shorter graft survival, have lost more grafts (P = 0.0003) , and more have died (P = 0.0197), than C patients.