# Trajectories of Medication Adherence in Pediatric Organ Transplantation and Their Relationship to Posttransplant Health Outcomes

> **NIH NIH R21** · FLORIDA STATE UNIVERSITY · 2021 · $233,436

## Abstract

Trajectories of Medication Adherence in Pediatric Organ Transplantation and Their Relationship to
Posttransplant Health Outcomes
Project Summary / Abstract
Non-adherence to immunosuppressive medication remains one of the most significant predictors of late acute
rejection (LAR), increased number and frequency of hospitalizations, need for retransplantation, and even
mortality in pediatric transplant patients. Medication Level Variability Index (MLVI) has been validated as a
measure of medication adherence and calculated from medication blood levels obtained during routine clinical
care of these patients. However, few studies have examined longitudinal trajectories of adherence to
immunosuppressive medication and possible differences in posttransplant outcomes. Further research is
necessary to understand variation in trajectories of medication adherence in pediatric organ transplantation
with Growth Mixture Modeling (GMM) proposed as a novel statistical approach. We propose to address these
gaps in knowledge by examining trajectories of MLVI values in data collected from one of the largest pediatric
transplant centers in the country. Patient and administrative data from the United Network for Organ Sharing
(UNOS, U.S. Department of Health and Human Services) will be electronically linked with patient electronic
health records (EHR). We will use latent growth curve analysis and a novel GMM three-step approach to this
analytic technique to 1) examine the association between patient and familial risk factors and long-term
posttransplant health outcomes, 2) estimate the functional form medication growth trajectories, 3) examine the
number of classes of growth in MLVI values and identify patients with similar classes, and 4) examine
association between classes of growth and both patient- and family-level predictors and posttransplant health
outcomes. Understanding the patient- and family-level predictors of classes of individual growth will inform
assessment and intervention efforts as to which patients and families may be greatest risk for non-adherence
over time and poor posttransplant outcomes. Results aim to be applicable to national pediatric organ transplant
centers, other areas of chronic illness in childhood and adolescence, and the basis for future research and
development of interventions.

## Key facts

- **NIH application ID:** 10183153
- **Project number:** 5R21AI148849-02
- **Recipient organization:** FLORIDA STATE UNIVERSITY
- **Principal Investigator:** Michael KILLIAN
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $233,436
- **Award type:** 5
- **Project period:** 2020-06-08 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10183153

## Citation

> US National Institutes of Health, RePORTER application 10183153, Trajectories of Medication Adherence in Pediatric Organ Transplantation and Their Relationship to Posttransplant Health Outcomes (5R21AI148849-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10183153. Licensed CC0.

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