Purpose: The pre-liver transplant (LT) psychosocial evaluation aims to identify risk factors for immunosuppression nonadherence (NA) and poor post-LT outcomes. Despite broad support for these evaluations, there is little agreement as to which risks should be evaluated. We investigated whether pre-LT psychosocial evaluation variables predict immunosuppression NA and biopsy-confirmed rejection post-LT.

Methods: This chart review, powered to show small to medium effect size, included 250 adults transplanted from 2009 to 2013 in a single center. Patients were at least 1 year post-LT with at least 3 trough tacrolimus levels. NA was determined using the medication level variability index (MLVI)[mdash]a validated measure for which values above 2 to 2.5 have been associated with rejection (Liver Transpl. 2014 Oct;20(10):1168-77). Predictor variables from the pre-LT evaluation were defined a priori. Outcomes (MLVI and rejection) were obtained 1 year post-LT to the present.

Results: Patients with rejection (N=41) had a significantly higher MLVI (t=2.71;p<.01). Multiple regression to predict MLVI (p=.45), and logistic regression to predict above threshold MLVI (p=.30) and rejection (p=.19) were not significant for any variable (Table).

Conclusions: Findings reconfirmed the MLVI's association with rejection establishing this index as a measure of clinically significant NA. None of the psychosocial variables predicted NA or rejection. Notably, race and substance abuse were not predictive of NA despite prior findings. These results challenge the adequacy of current practices to determine transplant eligibility. The presence of any one factor should not be interpreted to confer risk for post-LT NA or outcomes. A risk score accounting for cumulative effects of several risks may be preferred if validated in the future.

CITATION INFORMATION: Lieber S, Helcer J, Leven E, Knight C, Wlodarkiewicz C, Shenoy A, Shemesh E, Florman S, Schiano T, Annunziato R. Pre-Transplant Risk Factors: Predicting Nonadherence and Rejection in Adult Liver Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress