A remote intervention to improve medication nonadherence guided by a marker of risk derived from the electronic health records of adolescent transplant recipients
05/2026
Journal Article
Authors:
adherence behavioral intervention compliance liver transplant
Journal:
Am J Transplant
PMID:
42208859
URL:
https://www.ncbi.nlm.nih.gov/pubmed/42208859
Abstract:
Improving Medication Adherence in Adolescents who had a Liver Transplant (iMALT), a prospective, block-randomized, single-blind, controlled multisite study in 13 pediatric transplant centers, used the medication level variability index (MLVI) to identify non-adherent adolescents. It compared a two-year remote behavioral telemetric intervention (TI) that focused on adherence and addressed barriers, to standard of care (SOC). The primary endpoint was the composite incidence of centrally-determined (3 masked pathologists) rejection, death, re-transplantation, or consent withdrawal. In 148 participants (TI n=72, SOC n=76), mean age 15.5 years, there were twice as many primary events in SOC (12; 15.8%), as compared to TI (6; 8..3%) (RR 0.57, 95% CI 0.24-1.35, p=0.20). All secondary outcomes improved in TI vs. SOC. The study was underpowered, because iMALT sites used MLVI in clinical care, significantly reducing overall rejections as compared with the previous MALT cohort, where MLVI wasn't used (rejection observed in 12 / 76 patients in iMALT SOC vs 13 / 25 patients in MALT; p< 0.0001). The effect on the primary outcome, therefore, was not statistically significant; thus, the intervention is not evidence-based. MLVI, an electronic health record-derived behavioral marker, can be used to target interventions to patients with clinically significant nonadherence. ClinicalTrials.Gov, NCT03691220.