Medication level variability index predicts rejection, possibly due to nonadherence, in adult liver transplant recipients.
Medication level variability index predicts rejection, possibly due to nonadherence, in adult liver transplant recipients.
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DOI：
10.1002/lt.23930
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发表时间：
2014-10
影响因子：
4.6
通讯作者：
Shemesh, Eyal
中科院分区：
文献类型：
--
作者：
Supelana, Christina;Annunziato, Rachel A.;Schiano, Thomas D.;Anand, Ravinder;Vaidya, Swapna;Chuang, Kelley;Zack, Yelena;Florman, Sander;Shneider, Benjamin L.;Shemesh, Eyal
对免疫抑制剂的不依从性可能在肝移植受者晚期排斥反应中起作用。在儿童中，新出现的数据表明，依从性可以通过计算他克莫司连续血药浓度的标准差(SD)来衡量，得出的数字反映了各个指标之间的可变性程度(药物水平变异性指数，MLVI)。较高的MLVI值意味着不稳定的免疫抑制，可能是由于粘附性较低。有关成人这种方法的数据是有限的。我们从随机选择的150名成年受赠者的病历中获得数据。经活检证实有排斥反应的患者的MLVI(平均MLVI=3.8，SD=3.2)显著高于队列中的其余患者(平均MLVI=2.3，SD=1.5；p<；0.01)，而有排斥反应的患者的MLVI显著高于未被解读为排斥反应的活检患者(平均MLVI=2.6，SD=1.6；p<；0.01)。MLVI与排斥反应相关，并可预测排斥反应的发生。当阈值MLVI为2.0时，预测排斥反应的敏感度为77%，特异度为60%；阈值为1.8时，敏感度为92%，特异度为48%。受试者工作特征(ROC)曲线分析的曲线下面积(AUC)为0.71(95%CI：0.61~0.81)。MLVI与成人肝移植受者的排斥反应相关，并可以预测排斥反应，可能与排斥反应有关。
Nonadherence to immunosuppressants may play a role in late rejection in liver transplant recipients. In children, emerging data suggest that adherence can be measured by computing the standard deviation (SD) of consecutive blood levels of tacrolimus, resulting 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 in adults are limited. We obtained data from the medical charts of 150 randomly selected adult recipients. The MLVI was significantly higher in patients who had biopsy-confirmed rejection (mean MLVI=3.8, SD=3.2) as compared with the rest of the cohort (mean MLVI=2.3, SD=1.5; p<0.01), and it was significantly higher in patients who had a rejection as compared with patients who had a biopsy that was not read as a rejection (mean MLVI=2.6, SD=1.6; p<0.01). The MLVI was both 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 specificity of 48%. The Area Under the Curve (AUC) in a Receiver Operating Characteristic (ROC) curve analysis was 0.71 (95% CI: 0.61–0.81). The MLVI is associated with and can predict rejection, possibly related to nonadherence, in adult liver transplant recipients.
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