The Medication Level Variability Index (MLVI) Predicts Poor Liver Transplant Outcomes: A Prospective Multi-Site Study.
The Medication Level Variability Index (MLVI) Predicts Poor Liver Transplant Outcomes: A Prospective Multi-Site Study.
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DOI：
10.1111/ajt.14276
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发表时间：
2017-10
期刊：
影响因子：
--
通讯作者：
Shneider BL
中科院分区：
文献类型：
--
作者：
Shemesh E;Bucuvalas JC;Anand R;Mazariegos GV;Alonso EM;Venick RS;Reyes-Mugica M;Annunziato RA;Shneider BL
不坚持使用免疫抑制药物是导致移植受者长期预后不良的主要原因。药物水平变异性指数（MLVI）通过对依从性的持续评估，为移植结果风险分层提供了一种载体。MALT（接受肝移植儿童的药物依从性）前瞻性多中心研究评估了MLVI是否能预测晚期急性排斥反应（LAR）。400名儿童（1-17岁）肝移植受者入组并随访2年。先验假设是更高的MLVI预测LAR。预先定义的二次分析评估了其他结果，如肝酶水平，以及比较青春期和青春期前的敏感性分析。在379名参与者的主要分析样本中，较高的排斥前MLVI预测LAR[有LAR的平均排斥前MLVI: 2.4 (3.6 SD) vs.无LAR的平均排斥前MLVI: 1.6 (1.1)；p = 0.026)。第1年MLVI≤2的青少年中，53%在第2年末发生LAR，而第1年MLVI≤2的青少年中，这一比例为6%。较高的MLVI与所有次要结局显著相关。MLVI是一种使用临床来源信息的药物依从性标志物，可预测儿童肝移植受者的LAR。
Nonadherence to immunosuppressant medications is a leading cause of poor long-term outcomes in transplant recipients. The Medication Level Variability Index (MLVI) provides a vehicle for transplant outcome risk-stratification through continuous assessment of adherence. The MALT (Medication Adherence in children who had a Liver Transplant) prospective multi-site study evaluated whether MLVI predicts Late Acute Rejection (LAR). 400 pediatric (1–17 year old) liver transplant recipients were enrolled and followed for 2 years. The a-priori hypothesis was that a higher MLVI predicts LAR. Pre-defined secondary analyses evaluated other outcomes such as liver enzyme levels, and sensitivity analyses compared adolescent to pre-adolescents. In the primary analysis sample of 379 participants, a higher pre-rejection MLVI predicted LAR [mean pre-rejection MLVI with LAR: 2.4 (3.6 SD) vs. without LAR, 1.6 (1.1); p=0.026]. 53% of the adolescents with MLVI>2 in year 1 had LAR by the end of year 2, as compared with 6% of those with year 1 MLVI≤2. A higher MLVI was significantly associated with all secondary outcomes. MLVI, a marker of medication adherence that uses clinically-derived information, predicts LAR in pediatric liver transplant recipients.
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影响因子：
5.1
作者：
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