*Purpose: Purpose: Optimal allograft function and long-term graft survival depends on many factors, including adherence to a complex medication regimen. Methods of measuring adherence are retrospective and unreliable. A novel digital medicine program (DMP) that directly measures adherence was integrated into a solid organ transplant unit to enhance medical decision-making and improve clinical outcomes. This analysis describes the real-world impact of the DMP on adherence, healthcare utilization, and satisfaction in pediatric transplant patients.

*Methods: Methods: Patients/caregivers volunteered to use the DMP, which includes medications with ingestible sensors, a wearable sensor patch confirming ingestion, and a mobile app. The DMP captures and shares objective data to enable patients/caregivers/providers to address missed/incorrect doses and optimize therapy. Index date was the first scheduled ingestion date. Ingestion adherence, immunosuppression levels, utilization, and patient/caregiver satisfaction will be evaluated.

*Results: Results: A total of 46 patients used the DMP for a mean ± SD of 99 ± 86 days (mean age 14 ± 4 years, 59% female, 50% Caucasian, 37% African-American); 12 of which were pre-kidney transplant, and 34 were post-kidney, liver, or heart transplant. Overall mean ingestion adherence was 85 ± 13%. Non-adherence and medication dosing errors prompted timely, targeted interventions by the care team. When compared to 1-year pre-DMP, mean monthly rates of hospital admissions (0.32 vs 0.14, p=0.064) and emergency department visits (0.14 vs 0.05, p=0.107) were lower post-DMP. Of the 21 patients and 24 caregivers who responded to the satisfaction survey, 89% agreed that the DMP helped better manage the patient’s condition, and 91% agreed that it was easy to learn how to use the DMP.

*Conclusions: Conclusion: Digital medicines were successfully integrated into the care of pediatric solid organ transplant patients to record and communicate patterns of adherence, allowing for timely intervention to prevent allograft dysfunction in those post-transplant, and validation of adherence to optimize outcomes in those awaiting transplant. Downward trends in healthcare utilization suggest improved health outcomes. Future controlled studies are needed to evaluate the impact of the DMP on long-term allograft survival, clinical outcomes, and quality of life.

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