Variability index of tacrolimus serum levels in pediatric liver transplant recipients younger than 12 years: Non-adherence or risk of non-adherence?

Pediatr Transplant. 2017 Dec;21(8). doi: 10.1111/petr.13058. Epub 2017 Oct 15.

Abstract

MLVI has been used to assess adherence. To determine the MLVI in children <12 years of age at transplantation and to identify demographic correlates and consequences for the graft. This is a retrospective study of 50 outpatients (4.0 ± 3.5 years), at least 13-month post-liver transplantation. The outcomes evaluated were MLVI, ALT > 60 IU/L, ACR, death, and graft loss. We analyzed demographic and socioeconomic characteristics, indication for transplantation, and type of donor. Student's t test and the chi-square test were used. Statistical significance was set at P ≤ .05. Seventy-two percent were infants or preschoolers, 62% biliary atresia. Seventy-four percent of the mothers had middle-school education, and 54% of the families had an income ≤3632.4 US$/y. Twenty-two (44%) patients had a MLVI ≥ 2 SD; this was more prevalent in families with higher incomes (P = .045). ALT levels > 60 IU/L were more common in MLVI ≥ 2 SD group (P = .035). ACR episodes were similar between groups (P = 1.000). No patient died or lost the graft. MLVI ≥ 2 SD may be an indicator of the risk of medication non-adherence.

Keywords: children; liver transplantation; medication adherence; tacrolimus.

MeSH terms

  • Age Factors
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Graft Rejection / diagnosis
  • Graft Rejection / prevention & control
  • Humans
  • Immunosuppressive Agents / blood*
  • Immunosuppressive Agents / pharmacokinetics
  • Immunosuppressive Agents / therapeutic use
  • Infant
  • Liver Transplantation*
  • Male
  • Medication Adherence*
  • Outcome Assessment, Health Care
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Tacrolimus / blood*
  • Tacrolimus / pharmacokinetics
  • Tacrolimus / therapeutic use

Substances

  • Immunosuppressive Agents
  • Tacrolimus