ArticleLiver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society2014
Medication level variability index predicts rejection, possibly due to nonadherence, in adult liver transplant recipients.
Article in Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers.
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Who cites it
44 citing papers in PubMed.
- A remote intervention to improve medication nonadherence guided by a marker of risk derived from the electronic health records of adolescent transplant recipients.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2026Trial
- Randomized pilot trial of praise text messages to improve medication adherence among adolescents and young adults with liver transplants.Pediatric transplantation · 2022Trial
- Remote intervention engagement and outcomes in the Clinical Trials in Organ Transplantation in Children consortium multisite trial.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2021Trial
- Self-Management Measurement and Prediction of Clinical Outcomes in Pediatric Transplant.The Journal of pediatrics · 2018Trial
- Growth Trajectories of Medication Adherence in Pediatric Organ Transplantation and Their Relationship to Posttransplant Health Outcomes.Transplantation direct · 2026Article
- Neighborhood Deprivation Linked to Medication Level Variability in Liver Transplant Recipients.Clinical transplantation · 2025Article
- Oral medication adherence predicts cyclosporine blood level variability and graft versus host disease following pediatric allogeneic hematopoietic stem cell transplant.Annals of behavioral medicine : a publication of the Society of Behavioral Medicine · 2025Article
- SELF-REPORTED QUALITY OF LIFE, IMPULSIVITY AND NON-ADHERENCE TO IMMUNOSUPPRESSIVE MEDICATION AFTER LIVER TRANSPLANTATION: A COHORT STUDY.Arquivos de gastroenterologia · 2025Article
- Changes in Medication Adherence Across the Posttransplant Period in Pediatric Organ Transplant Recipients.Clinical transplantation · 2024Article
- Impact of Intrapatient Immunosuppression Variability in Liver Transplantation Outcomes: A Systematic Review and Meta-analysis.Transplantation direct · 2024Article
- High intra-patient variability of tacrolimus within post-operative 1 month predicted worse 1-year outcomes in pediatric liver transplant recipients.European journal of clinical pharmacology · 2024Article
- Alcoholic Etiology, Severity of Liver Disease, and Post-Transplant Adherence Are Correlated with Worse Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) in Liver Transplant Candidates.Journal of clinical medicine · 2024Article
- Demographic Factors, Medication Adherence, and Post-transplant Health Outcomes: A Longitudinal Multilevel Modeling Approach.Journal of clinical psychology in medical settings · 2024Article
- Erratic tacrolimus levels at 6 to 12 months post-lung transplant predicts poor outcomes.JHLT open · 2024Article
- The improving Medication Adherence in Adolescents and young adults following Liver Transplantation (iMALT) multisite trial: Design and trial implementation considerations.Clinical trials (London, England) · 2023Article
- Impact of tacrolimus intra-patient variability in adverse outcomes after organ transplantation.World journal of transplantation · 2023Review
- Article
- High intrapatient variability of tacrolimus exposure associated with poorer outcomes in liver transplantation.Clinical and translational science · 2022Article
- Early Survivorship After Liver Transplantation: A Qualitative Study Identifying Challenges in Recovery From the Patient and Caregiver Perspective.Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society · 2022Article
- Posttraumatic stress and medication adherence in pediatric transplant recipients.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2022Article
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10 authors.
Funding
Abstract
Nonadherence to immunosuppressants may play a role in late rejection in liver transplant recipients. In children, emerging data suggest that adherence can be measured through the computation of the standard deviation (SD) of consecutive blood levels of tacrolimus, which results in a number that reflects the degree of variability between individual measures: the medication level variability index (MLVI). A higher MLVI value means erratic immunosuppression, likely due to less adherence. Data on this method are limited for adults. We obtained data from the medical charts of 150 randomly selected adult recipients. The MLVI was significantly higher for patients who had biopsy-confirmed rejection (mean MLVI = 3.8, SD = 3.2) versus the rest of the cohort (mean MLVI = 2.3, SD = 1.5, P = 0.003), and it was significantly higher for patients who suffered rejection versus patients whose biopsy sample was not read as rejection (mean MLVI = 2.6, SD = 1.6, P = 0.008). The MLVI was associated with rejection and predicted its occurrence. A threshold MLVI of 2.0 resulted in 77% sensitivity and 60% specificity in predicting rejection; a threshold of 1.8 resulted in a sensitivity of 92% and a specificity of 48%. The area under the curve in a receiver operating characteristic curve analysis was 0.71 (95% CI = 0.61-0.81). In conclusion, the MLVI is associated with and can predict rejection, possibly related to nonadherence, in adult liver transplant recipients.
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