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. 2014 Oct;20(10):1168-77.
doi: 10.1002/lt.23930. Epub 2014 Aug 26.

Medication level variability index predicts rejection, possibly due to nonadherence, in adult liver transplant recipients

Supelana Christina  1 , Rachel A Annunziato, Thomas D Schiano, Ravinder Anand, Swapna Vaidya, Kelley Chuang, Yelena Zack, Sander Florman, Benjamin L Shneider, Eyal Shemesh
Affiliations

Medication level variability index predicts rejection, possibly due to nonadherence, in adult liver transplant recipients

Supelana Christina et al. Liver Transpl. 2014 Oct.

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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Conflict of interest statement

Conflicts of Interest: The authors of this manuscript have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Enrollment flowchart.
FIGURE 2
FIGURE 2
Distribution of MLVI values, by rejection status. Patient (%) denotes the percent of patients amongst all of the patients in the rejection – blue, or no rejection – red categories in each MLVI value range (each category adds up to 100%). Note: MLVI=Medication Level Variation Index.
FIGURE 3
FIGURE 3
Distribution of tacrolimus blood level values in the entire cohort.
FIGURE 4
FIGURE 4
Receiver operating characteristic (ROC) curve for the relationship between MLVI values and rejection. Diagonal segments are produced by ties. The area under the curve is 0.71. Note: MLVI=Medication Level Variation Index.
See this image and copyright information in PMC

References

    1. Shemesh E, Shneider BL, Emre S. Adherence to medical recommendations in pediatric transplant recipients: time for action. Pediatr Transplant. 2008;12(3):281–3. - PubMed
    1. Shemesh E, Shneider BL, Savitzky JK, Arnott L, Gondolesi GE, Krieger NR, et al. Medication adherence in pediatric and adolescent liver transplant recipients. Pediatrics. 2004;113(4):825–32. - PubMed
    1. Shemesh E. Nonadherence to medications following pediatric liver transplantation. Pediatr Transplant. 2004;8(6):600–5. - PubMed
    1. Molmenti E, Mazariegos G, Bueno J, Cacciarelli T, Alasio T, Khanna A, et al. Noncompliance after pediatric liver transplantation. Transplant Proc. 1999;31(1–2):408. - PubMed
    1. Shemesh E, Lurie S, Stuber ML, Emre S, Patel Y, Vohra P, et al. A pilot study of posttraumatic stress and nonadherence in pediatric liver transplant recipients. Pediatrics. 2000;105(2):E29. - PubMed

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