title: Medication adherence and rejection rates in older vs younger adult liver transplant recipients.
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.
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Emily A
authors.identifier: 0000-0001-7508-5908
authors.initials: EA
authors.lastname: Leven
authors.affiliation: Departments of Pediatrics and Psychiatry, Icahn School of Medicine at Mount Sinai, Fordham University, New York, NY, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Annunziato
authors.affiliation: Departments of Pediatrics and Psychiatry, Icahn School of Medicine at Mount Sinai, Fordham University, New York, NY, USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Helcer
authors.affiliation: Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Lieber
authors.affiliation: Departments of Pediatrics and Psychiatry, Icahn School of Medicine at Mount Sinai, Fordham University, New York, NY, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Knight
authors.affiliation: Fordham University, New York, NY, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Wlodarkiewicz
authors.affiliation: Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Rainier P
authors.initials: RP
authors.lastname: Soriano
authors.affiliation: Recanati Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Sander S
authors.initials: SS
authors.lastname: Florman
authors.affiliation: Intestinal Transplant Program, Recanati Miller Transplant Institute, Mount Sinai Hospital, New York, NY, USA.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Schiano
authors.affiliation: Division of Developmental Behavioral Pediatrics, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Eyal
authors.initials: E
authors.lastname: Shemesh
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy* / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D007166:Immunosuppressive Agents
keywords: biomarkers; graft rejection; medication adherence