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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
PubMed

Insights

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.

Keywords:
LongitudinalMLVIMedication adherencePediatric organ transplantation

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