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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Key takeaways: A novel marker based on routine lab values can identify transplant recipients at high risk for organ rejection due to medication nonadherence. Clinicians could then target interventions for those patients. Use of an electronic health record-based marker could help clinicians identify liver transplant recipients who are at risk for organ rejection due to medication nonadherence. Study findings published in American Journal of Transplantation showed adolescents and young adults assigned to a 2-year remote behavioral intervention after transplantation experienced half as many primary events \u2014 a combination of rejection, retransplantation and consent withdrawal \u2014 as those assigned standard of care.
The study did not reach statistical significance for its primary endpoint, but demonstrated that use of an objective marker \u2014 derived from routine lab values already found in the EHR \u2014could help reduce rejection rates. \u201cI can\u2019t say the effect of the intervention was significant, but oh boy, can I say that the marker works \u2014 and that\u2019s way more important,\u201d Eyal Shemesh, MD, principal investigator and chief of the division of behavioral and developmental health at Mount Sinai Kravis Children\u2019s Hospital, told Healio. \u201cWe saw a huge reduction in rejection across the board. I think that is the most important and really amazing result from the research.\u201d Shemesh and colleagues developed the medication level variability index (MLVI), which uses fluctuations in routine immunosuppressive blood levels to identify inconsistencies in medication adherence. Clinicians can then intervene before adverse events occur. The researchers investigated whether MLVI scores could affect transplant outcomes by conducting a prospective, single-blind study at 13 pediatric liver transplant centers in the United States and Canada. Shemesh and colleagues reviewed the electronic health records of several thousand transplant recipients at those participating centers, using the MLVI marker to identify patients at high risk for imminent organ rejection. From the few hundred patients classified as high risk, they randomly assigned 148 adolescent and young adult liver transplant recipients (mean age, 15.5 years) to either the behavioral intervention (n = 72) or standard care (n = 76). Results showed 8.3% of participants in the intervention group experienced rejection compared with 15.8% in the standard of care group (RR = 0.57; 95% CI, 0.24-1.35). Healio spoke with Shemesh about the study\u2019s inception, the creation of the MLVI marker and its potential generalizability in other settings to identify patients at risk for adverse outcomes. Healio: What clinical observations led you and your team to pursue this research?? Shemesh: I\u2019ve been interested in the idea that patients don\u2019t take their medicines for a long time. It actually came from another interest I had in psychiatric disorders where my team showed that patients with PTSD are less likely to take their medicines because they are a reminder of the stressor. We then wondered how we can know whether patients are not taking their medication. What would be a way to figure that out? We know already that asking patients is not good enough. They\u2019re not always going to tell us the truth. We know the problem is more prominent in adolescents, and while it has different implications depending on the disease process, it is incredibly important in transplant medicine that patients take their immunosuppressants. In transplant medicine, we check blood levels of the immunosuppressant routinely to figure out how much we should prescribe. If patients are not taking their medication consistently, those levels will either be low or high, because they\u2019re either not taking enough of the medicine or they may take a double dose when they know a blood test is coming if they didn\u2019t take it the day before. They can \u2018fool\u2019 one test to show a high level, but they cannot \u2018fool\u2019 a series of tests to show a stable level over time. My research team and I came up with the idea to calculate the degrees of variability between the medication blood levels, rather than looking at just one level. Healio: How does the MLVI work and how did you incorporate it into this study design? Shemesh: It does two things. First, it gives you an idea of inconsistent medication-taking, but it also gives you an idea over time of patients who you know are chronically not taking it, not just those who sometimes forget \u2014 and those are the patients we want to pick up. Those who occasionally miss a single dose are generally doing well and not who we want to target with these interventions. We want to target those patients who have been consistently missing their medications over an extended period and are therefore at truly increased medical risk, and the MLVI marker only flags these chronically nonadherent patients. We concentrated on adolescents and young adults who were seen in 13 pediatric transplant centers in the United States and Canada over a period of several years. We calculated this metric and whenever somebody met the threshold, we would try to get them into research. We were actually quite successful in recruiting those patients because we were able to tell them they are at-risk due to the metric we already had. Since our intervention was remote, we were also able to engage them. This is important because many adherence interventions require patients to come to the clinic weekly. If a patient is already struggling to take medication as prescribed, it is unlikely they will be able to keep weekly clinic visits. But with this remote intervention, we came to them. Healio: The study did not meet its primary endpoint but still showed encouraging data. What is your interpretation of the results? Shemesh: We had 18 primary<\/p>\n","protected":false},"author":1,"featured_media":3158,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-3157","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3157","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3157"}],"version-history":[{"count":0,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3157\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/media\/3158"}],"wp:attachment":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3157"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3157"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3157"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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