A Remote Intervention To Improve Medication Nonadherence Guided by a Marker of Risk Derived From the Electronic Health Records of Adolescent Transplant Recipients

Authors

• Eyal Shemesh
• Ravinder Anand
• Rachel A Annunziato
• Emily M Fredericks
• Jennifer Garcia
• Nitika Arora Gupta
• Lawrence C Kleinman
• Alyssa Kriegermeier
• Krupa R Mysore
• Vicky L Ng
• Steven J Lobritto
• Shreena Patel
• Emily Rothbaum Perito
• Elizabeth B Rand
• Rene Romero
• Robert S Venick
• Sarah Duncan-Park
• Jeffrey Mitchell
• Sarah G Anderson
• Margaret L Stuber
• Miguel Reyes-Múgica
• George V Mazariegos
• Benjamin L Shneider

Language

English

Publication Date

5-27-2026

Journal

American Journal of Transplantation

DOI

10.1016/j.ajt.2026.04.030

PMID

42208859

PMCID

PMC13320516

PubMedCentral® Posted Date

7-2-2026

PubMedCentral® Full Text Version

Author MSS

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 nonadherent adolescents. It compared a 2-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, retransplantation, or consent withdrawal. In 148 participants (TI group, n = 72 and the SOC group, n = 76), with a mean age 15.5 years, there were twice as many primary events in SOC (12; 15.8%) compared with TI (6; 8.3%) (relative risk, 0.57; 95% confidence interval, 0.24-1.35; P = .20). All secondary outcomes improved in the TI vs SOC groups. The study was underpowered because iMALT study sites used the MLVI score in clinical care, significantly reducing overall rejections compared with the previous MALT study cohort, where the MLVI score was not used (rejection was observed in 12/76 patients in the iMALT study, SOC vs 13/25 patients in the MALT study; P < .0001). The effect on the primary outcome, therefore, was not statistically significant; thus, the intervention is not evidence-based. MLVI score, an electronic health record-derived behavioral marker, can be used to target interventions to patients with clinically significant nonadherence.

Keywords

adherence, compliance, liver transplant, behavioral intervention

Comments

ClinicalTrials.Gov, NCT03691220

Published Open-Access

yes

Recommended Citation

Shemesh, Eyal; Anand, Ravinder; Annunziato, Rachel A; et al., "A Remote Intervention To Improve Medication Nonadherence Guided by a Marker of Risk Derived From the Electronic Health Records of Adolescent Transplant Recipients" (2026). Faculty, Staff and Students Publications. 7559.
https://digitalcommons.library.tmc.edu/baylor_docs/7559