Noncompliance with medications in pediatric patients after living-donor liver transplantation.

INTRODUCTION: Noncompliance with immunosuppressant therapy is a serious problem that leads to the possibility of graft rejection, even in the long term after liver transplantation. The objectives of the present study were to review and describe features of patient noncompliance after living-donor liver transplantation (LDLT). PATIENTS AND METHODS: Among pediatric patients (age <18 years) surviving more than 5 years after LDLT, noncompliant patients were identified, and their clinicopathologic characteristics were studied retrospectively. RESULTS: Of 108 pediatric recipients who survived more than 5 years after LDLT, 6 female patients (5.6%) were noncompliant. Median (range) age at transplantation was 5 (2-15) years, and at noncompliance was 18 (9-21) years. Median time to noncompliance after transplantation was 8 (5-16) years. The 6 noncompliant patients received increased immunosuppression therapy, and liver function test results improved. Noncompliance was improved via intervention with medication, but recurred in 2 patients (33%). Noncompliance did not result in graft or patient loss. CONCLUSION: The prevalence of noncompliance was not so high in LDLT recipients. Liver dysfunction secondary to noncompliance improved with increased immunosuppression therapy.

[Melanotic schwannoma with a high level of catecholamine in an elderly patient].

A 73-year-old woman suffering from hypertension and asthma had chest radiography, which showed the shadow of a lump on the inner side of the right lung apex. From a chest CT scan, it was diagnosed as an upper mediastinal tumor (circular in shape with a diameter of 19 x 23 mm) adjacent to the right rib and showing a low-absorption range. Histopathology confirmed the diagnosis as an Antoni B-type melanotic schwannoma. On suspicion of secondary hypertension, the amount of urinary catecholamine was measured before surgery and this revealed high levels of total catecholamine (184.4 micrograms/day), dopamine (1134.6 micrograms/day) and noradrenaline (169.7 micrograms/day). A normal value of 14.7 micrograms/day of adrenalin was obtained. These measurements were conducted again after surgery, and normal values of 127.8 micrograms/day of total catecholamine, 388.6 micrograms/day of dopamine, 117.9 micrograms/day of noradrenalin and 9.9 micrograms/day of adrenalin were obtained. In view of these findings, the tumor was thought to be a neurogenic tumor of the sympathetic nervous system and capable of generating melanin. Incidentally, after removal of the tumor, the patient's hypertension became less severe and there was improvement in her asthma attacks.