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Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
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Demographic Factors, Medication Adherence, and Post-transplant Health Outcomes: A Longitudinal Multilevel Modeling
Michael O Killian1,2, Callie W Little3, Savarra K Howry3
1College of Social Work, University Center, Florida State University, 296 Champions Way, Building C - Suite 2500, Tallahassee, FL, USA. mkillian@fsu.edu.
Journal of Clinical Psychology in Medical Settings
|August 17, 2023
Summary
Longitudinal medication adherence in pediatric transplant patients significantly impacts outcomes like rejection and hospitalizations. Interventions should target high-risk individuals, particularly adolescents, for better medication adherence.
Area of Science:
- Pediatric Solid Organ Transplantation
- Immunosuppressive Medication Adherence
- Transplant Outcomes Research
Background:
- Limited research exists on long-term immunosuppressive medication non-adherence in pediatric solid organ transplantation.
- Understanding adherence patterns and their link to patient demographics and post-transplant outcomes is crucial.
Purpose of the Study:
- To examine longitudinal variations in medication adherence using the Medication Level Variability Index (MLVI) in pediatric kidney, liver, and heart transplant recipients.
- To investigate the association between adherence variability and post-transplant outcomes, including late acute rejection and hospitalizations.
- To explore the mediating role of adherence in the relationship between patient factors and transplant outcomes.
Main Methods:
- Longitudinal MLVI adherence data were analyzed for 332 pediatric solid organ transplant recipients over 10 years.
- Data were linked from the United Network for Organ Sharing, electronic health records, and MLVI values.
- Multilevel mediation modeling was employed to assess variation and predictive relationships.
Main Results:
- Greater variation in MLVI values was observed between patients than within patients longitudinally.
- MLVI values significantly predicted both late acute rejection and hospitalizations.
- MLVI partially mediated patient factors and post-transplant outcomes, with adolescents showing potential benefit from interventions.
Conclusions:
- Longitudinal assessment of medication adherence is vital in pediatric solid organ transplantation.
- Patient-specific adherence patterns influence transplant outcomes, highlighting the need for individualized approaches.
- Targeted interventions for high-risk patients, especially adolescents, may improve medication adherence and transplant success.
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