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Medication adherence and rejection rates in older vs younger adult liver transplant recipients |
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| Authors: | Emily A Leven Rachel Annunziato Jacqueline Helcer Sarah R Lieber Christopher S Knight Catherine Wlodarkiewicz Rainier P Soriano Sander S Florman Thomas D Schiano Eyal Shemesh |
| Institution: | 1. Icahn School of Medicine at Mount Sinai, New York, NY, USA;2. Departments of Pediatrics and Psychiatry, Icahn School of Medicine at Mount Sinai, Fordham University, New York, NY, USA;3. Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA;4. Fordham University, New York, NY, USA;5. Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA;6. Recanati Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA;7. Intestinal Transplant Program, Recanati Miller Transplant Institute, Mount Sinai Hospital, New York, NY, USA;8. Division of Developmental Behavioral Pediatrics, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA |
| Abstract: | A growing number of older adults are undergoing liver transplantation (LT) in the United States. In some settings, it is thought that adherence declines with age. This retrospective study examined adherence and clinical outcomes in older vs younger adult LT recipients. Medical records of adult LT recipients from 2009 to 2012 from a single urban center were reviewed. The medication level variability index (MLVI) was the predefined primary outcome, with nonadherence defined as MLVI >2.5. The secondary outcome was incidence of rejection. Outcomes were evaluated starting 1 year post‐LT until 2015. A total of 42 of 248 patients were ≥65 at transplant. Older adults had significantly better adherence than younger ones (65%≥65 were adherent vs 42% younger adults; chi‐square two‐tailed P=.02). Survival analyses of rejection between age groups censored by time since transplant showed no difference among the four age groups (χ2=0.84, P=.84). Older age was not found to be a risk factor for reduced adherence or graft rejection in patients surviving at least 1 year post‐LT. |
| Keywords: | biomarkers graft rejection medication adherence |