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Adherence to Immunosuppressive Medication Leads to Better Outcomes in Young Liver Transplant Recipients

A study of children around the country who received liver transplants has found that a tool to measure their adherence to taking immunosuppressive medication can predict organ rejection later. Life-saving liver transplants rely on use of a scarce resource—organs from living or deceased donors—and they also generate high health-care costs. Efforts to improve outcomes after organ transplantation benefit the recipients’ health, as well as optimize use of the transplanted organs. A leading factor in determining outcomes for organ transplant recipients in the long term, including whether the body rejects the transplant and recipient survival, is consistently taking immunosuppressive medications as prescribed. These medications are required life-long after transplant to avoid the body’s rejection of the transplanted organ. Researchers developed a tool to gauge medication adherence in transplant recipients based on blood levels of the medication over time called the Medication Level Variability Index (MLVI). They tested it within a study of 400 children ages 1 to 17 who had received liver transplants at five centers throughout the United States and were then followed for 2 years after. Although there were no deaths or organ failures requiring re-transplantation during the study, liver biopsies from some participants showed signs of transplant rejection associated with lower medication adherence. For example, 53 percent of adolescents who had a higher MLVI score in the first year of the study, indicating lower adherence to medication, showed signs of transplant rejection in the following year. This study demonstrates that the MLVI is a useful tool for predicting which pediatric liver transplant recipients, particularly those who are adolescents, are at risk for eventual transplant rejection based on not taking their immunosuppressive medication as prescribed. Further clinical trials are needed to test behavioral interventions, based on MLVI score, to improve medication adherence. However, this knowledge could one day help health care providers to better monitor pediatric liver transplant recipients, especially adolescents, and to intervene before transplant rejection occurs.

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