The Medication Level Variability Index (MLVI) Predicts Poor Liver Transplant Outcomes: A Prospective Multi-Site Study

E. Shemesh, J. C. Bucuvalas, R. Anand, G. V. Mazariegos, E. M. Alonso, R. S. Venick, M. Reyes-Mugica, R. A. Annunziato, B. L. Shneider

Research output: Contribution to journalArticlepeer-review

94 Scopus citations


Nonadherence to immunosuppressant medications is a leading cause of poor long-term outcomes in transplant recipients. The Medication Level Variability Index (MLVI) provides a vehicle for transplant outcome risk-stratification through continuous assessment of adherence. The MALT (Medication Adherence in children who had a Liver Transplant) prospective multi-site study evaluated whether MLVI predicts late acute rejection (LAR). Four hundred pediatric (1–17-year-old) liver transplant recipients were enrolled and followed for 2 years. The a-priori hypothesis was that a higher MLVI predicts LAR. Predefined secondary analyses evaluated other outcomes such as liver enzyme levels, and sensitivity analyses compared adolescents to pre-adolescents. In the primary analysis sample of 379 participants, a higher prerejection MLVI predicted LAR (mean prerejection MLVI with LAR: 2.4 [3.6 standard deviation] versus without LAR, 1.6 [1.1]; p = 0.026). Fifty-three percent of the adolescents with MLVI>2 in year 1 had LAR by the end of year 2, as compared with 6% of those with year 1 MLVI≤2. A higher MLVI was significantly associated with all secondary outcomes. MLVI, a marker of medication adherence that uses clinically derived information, predicts LAR in pediatric liver transplant recipients.

Original languageEnglish
Pages (from-to)2668-2678
Number of pages11
JournalAmerican Journal of Transplantation
Issue number10
StatePublished - Oct 2017


  • biomarker
  • calcineurin inhibitor
  • clinical research/practice
  • clinical trial
  • compliance/adherence
  • immunosuppressant
  • liver allograft function/dysfunction
  • liver transplantation/hepatology
  • organ transplantation in general
  • pediatrics
  • tacrolimus


Dive into the research topics of 'The Medication Level Variability Index (MLVI) Predicts Poor Liver Transplant Outcomes: A Prospective Multi-Site Study'. Together they form a unique fingerprint.

Cite this