Implementation of a multicomponent medication adherence promotion system is associated with a decrease in late...

Area of Science:

• Pediatric Transplant Surgery
• Immunology
• Quality Improvement Science

Background:

• Poor immunosuppression adherence is a primary driver of late T-cell-mediated rejection (TCMR) in pediatric liver transplant (LT) recipients, impacting ~90% of cases and increasing mortality risk.
• The Medication Adherence Promotion System (MAPS) has previously demonstrated efficacy in reducing rejection rates in pediatric kidney transplant recipients.

Purpose of the Study:

• To adapt and implement the MAPS within a pediatric LT clinic setting.
• To evaluate the impact of MAPS on population-level rates of late TCMR in pediatric LT recipients.

Main Methods:

• Quality improvement methodology was employed to adapt and implement the MAPS.
• The primary outcome measured was the monthly incident rate of late TCMR.
• Data were collected from 314 pediatric LT recipients at a single institution over a 2.3-year implementation period.

Main Results:

• Preimplementation, monthly TCMR rates were 0.84 rejections per 100 patient-months.
• Following iterative MAPS implementation, monthly TCMR rates decreased to 0.46 rejections per 100 patient-months, representing a 45% reduction.
• The reduction in late TCMR was sustained throughout the study period.

Conclusions:

• MAPS implementation was associated with a significant and sustained 45% decrease in TCMR in pediatric LT recipients at a single center.
• Quality improvement tools like MAPS show promise in improving clinical outcomes and ensuring long-term allograft health in this vulnerable population.
• Further multicenter studies are warranted to rigorously validate the effectiveness of MAPS across diverse transplant centers.