Self-Management Measurement and Prediction of Clinical Outcomes in Pediatric Transplant

Rachel A. Annunziato*, John C. Bucuvalas, Wanrong Yin, Ravinder Arnand, Estella M. Alonso, George V. Mazariegos, Robert S. Venick, Margaret L. Stuber, Benjamin L. Shneider, Eyal Shemesh

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


Objective: To further refine a measure of self-management, the Responsibility and Familiarity with Illness Survey (REFILS), and to determine if this score predicts medication adherence and, thus, fewer instances of allograft rejection among pediatric liver transplant recipients. Study design: Participants were 400 liver transplant recipients and their parents recruited for the Medication Adherence in Children Who Had a Liver Transplant study, from 5 US pediatric transplant centers. The REFILS was administered to participants (ages 9-17 years) and their parents at enrollment (n = 213 completed dyads). The REFILS scores, and a discrepancy score calculated between patient and parent report of the patient's self-management, were used to predict Medication Level Variability Index (MLVI), a measure of medication adherence (higher MLVI = more variability in medication levels) and central pathologist-diagnosed rejection over a 2-year follow-up. Results: When patients reported greater self-management, their adherence was lower (higher MLVI, r = 0.26, P <.01). Discrepancies between patient and parent report (patients endorsing higher levels than parents) were associated with lower adherence (r = 0.20, P <.01). Greater patient-reported self-management and higher discrepancy scores also predicted rejection. Conclusions: We found that when patients endorse more responsibility for their care, clinical outcomes are worse, indicating that indiscriminate promotion of self-management by adolescents may not be advisable. A discrepancy between patient and parent perception of self-management emerged as a novel strategy to gauge the degree of risk involved in transitioning care responsibilities to the child.

Original languageEnglish (US)
Pages (from-to)128-133.e2
Journaljournal of pediatrics
StatePublished - Feb 2018


  • adherence
  • pediatric transplant
  • self-management
  • transition

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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