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The Medication Level Variability Index (MLVI) Predicts Poor Liver Transplant Outcomes: A Prospective Multi-Site

E Shemesh1, J C Bucuvalas2, R Anand3

  • 1Icahn School of Medicine at Mount Sinai, New York, NY.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|March 22, 2017
PubMed
Summary
This summary is machine-generated.

Medication adherence is crucial for liver transplant recipients. The Medication Level Variability Index (MLVI) effectively predicts late acute rejection in pediatric liver transplant patients, improving long-term outcomes.

Keywords:
biomarkercalcineurin inhibitorclinical research/practiceclinical trialcompliance/adherenceimmunosuppressantliver allograft function/dysfunctionliver transplantation/hepatologyorgan transplantation in generalpediatricstacrolimus

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Area of Science:

  • Transplantation research
  • Pediatric gastroenterology
  • Pharmacology

Background:

  • Nonadherence to immunosuppressants is a primary driver of poor outcomes in transplant recipients.
  • The Medication Level Variability Index (MLVI) offers a method for continuous adherence assessment and transplant outcome risk-stratification.

Purpose of the Study:

  • To evaluate if the MLVI predicts late acute rejection (LAR) in pediatric liver transplant recipients.
  • To assess the association between MLVI and other outcomes like liver enzyme levels.
  • To compare outcomes between adolescents and pre-adolescents.

Main Methods:

  • Prospective, multi-site study (MALT) involving 400 pediatric liver transplant recipients (ages 1-17).
  • Participants were followed for 2 years.
  • Primary analysis focused on 379 participants, examining prerejection MLVI in relation to LAR.

Main Results:

  • A higher prerejection MLVI was a significant predictor of LAR (p = 0.026).
  • Adolescents with an MLVI > 2 in year 1 had a significantly higher incidence of LAR by year 2 (53%) compared to those with MLVI ≤ 2 (6%).
  • Increased MLVI was associated with all secondary outcomes, including liver enzyme levels.

Conclusions:

  • The MLVI is a clinically derived marker of medication adherence.
  • MLVI effectively predicts late acute rejection in pediatric liver transplant recipients.
  • This index can aid in risk-stratification and potentially improve long-term transplant outcomes.