Background & Objectives: Medication non-adherence remains problematic in pediatric liver transplant (LT)[mdash]estimates suggest that up to 53% of adolescents are non-adherent. We leveraged data from subjects who were enrolled in the MALT clinical trial (NCT01154075) to learn if community deprivation predicted non-adherence in pediatric LT recipients.

Methods: This was a single-center pilot study. The primary outcome was Medication Level Variability Index (MLVI); an objective, validated biomarker of non-adherence. Primary exposure, derived from participant addresses, was a validated index of community deprivation using data from the US Census Bureau. The index has a range of [0, 1] with higher values indicating greater deprivation.

Results: Deprivation measures were extracted from 75/80 patients (93.8%). Patients were stratified into three groups of adherence severity: adherent (MLVI <2.0), non-adherent (MLVI 2.0-3.5) and severe non-adherent (MLVI >3.5). Mean deprivation index was 0.38, 0.35 and 0.51, respectively (Figure 1; ANOVA p = 0.03). The odds ratio for being severe non-adherent with every 0.1 increase in the deprivation index was 4.2 [95% CI 1.34-21.99]. Patients were then stratified by adherence persistence. Mean deprivation index by adherence persistence was 0.38, 0.34 and 0.44 for always adherent, sometimes adherent and always non-adherent, respectively (Figure 2; ANOVA p = 0.10).

Conclusion: The results indicate that adherent patients live across the spectrum of deprivation[mdash]suggesting that living in a deprived community does not necessarily equate to non-adherence. However, of the non-adherent patients, the data suggest that patients from more deprived communities have a more persistent and severe form of non-adherence. Further work is needed to better characterize this association.

CITATION INFORMATION: Wadhwani S., Taylor S., Brokamp C., Guo W., Shemesh E., Bucuvalas J. Medication Adherence: Does Where You Live Matter? Am J Transplant. 2017;17 (suppl 3).

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