*Purpose: Historically our focus in transplantation has been on 1 year patient and graft outcomes. With the proposed shifts in legislation and the more recent focus on long term outcomes the txp community needs to dedicate research into >1 year outcomes. Medication adherence issues are thought to be a major cause of late rejection and allograft loss and have not been thoroughly evaluated in long-term liver transplant (LTx) patients. The aim of this study is to examine the differences in adherence and medication expectations in long term LTx patients based upon side effect burden (SEB).

*Methods: LTx recipients 18+ years of age were surveyed about medication adherence and adverse effects commonly associated with immunosuppressant medications. Patients were compared based upon a validated mean side effect burden score. The primary outcome was medication adherence score (MAS) categorized by level of adherence. The secondary outcome was presence of medication barriers. Patients were excluded if they were <1 year post-txp. Descriptive statistics were used to evaluate baseline demographics and answers to adherence questions.

*Results: 73 patients were surveyed, and 71 completed surveys from 3/2018 to 11/2018. Fifty respondents were >1 year post-txp. The average side effect score was 9.3±13.4 and 62% of patients had a SEB < the mean. Patients with a SEB>9.3 were more likely younger at the time of transplant and female (table 1). SEB>9.3 were more likely to have self-reported low adherence vs those with SEB <mean (47% vs 18%, p=0.047, Table 2) and were more likely to cut back on medications without notifying their MD.

*Conclusions: Long term LTx patients who reported low medication adherence and cut back on their meds were significantly more likely to have an above average SEB. Interestingly, there was no difference in healthcare barriers. Focus on side effect burden in patients >1 year may yield improved overall medication adherence.

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