2026-06-15 マウントサイナイ医療システム（MSHS）
＜関連情報＞
- https://www.mountsinai.org/about/newsroom/2026/new-study-suggests-novel-ehr-based-marker-can-identify-at-risk-transplant-patients-and-reduce-organ-rejection
- https://www.sciencedirect.com/science/article/abs/pii/S1600613526002388
思春期の臓器移植患者の電子カルテから得られたリスク指標に基づき、服薬遵守率を改善するための遠隔介入。 A remote intervention to improve medication nonadherence guided by a marker of risk derived from the electronic health records of adolescent transplant recipients.
Eyal Shemesh M.D, Ravinder Anand Ph.D, Rachel A. Annunziato Ph.D, Emily M. Fredericks Ph.D, Jennifer Garcia M.D, Nitika Arora Gupta M.D, Lawrence C. Kleinman M.D, Alyssa Kriegermeier M.D, Krupa R. Mysore M.D, Vicky L. Ng M.D, Steven J. Lobritto M.D, Shreena Patel M.D, Emily Rothbaum Perito M.D, Elizabeth B. Rand M.D, Rene Romero M.D, Robert S. Venick M.D, Sarah Duncan-Park Ph.D, Jeffrey Mitchell BSc, Sarah G. Anderson MSc, Margaret L. Stuber M.D …Benjamin L. Shneider M.D
American Journal of Transplantation Available online: 27 May 2026
DOI:https://doi.org/10.1016/j.ajt.2026.04.030
ABSTRACT
Improving Medication Adherence in Adolescents who had a Liver Transplant (iMALT), a prospective, block-randomized, single-blind, controlled multisite study in 13 pediatric transplant centers, used the medication level variability index (MLVI) to identify non-adherent adolescents. It compared a two-year remote behavioral telemetric intervention (TI) that focused on adherence and addressed barriers, to standard of care (SOC). The primary endpoint was the composite incidence of centrally-determined (3 masked pathologists) rejection, death, re-transplantation, or consent withdrawal. In 148 participants (TI n=72, SOC n=76), mean age 15.5 years, there were twice as many primary events in SOC (12; 15.8%), as compared to TI (6; 8·.3%) (RR 0·57, 95% CI 0.24-1.35, p=0.20). All secondary outcomes improved in TI vs. SOC. The study was underpowered, because iMALT sites used MLVI in clinical care, significantly reducing overall rejections as compared with the previous MALT cohort, where MLVI wasn’t used (rejection observed in 12 / 76 patients in iMALT SOC vs 13 / 25 patients in MALT; p< 0.0001). The effect on the primary outcome, therefore, was not statistically significant; thus, the intervention is not evidence-based. MLVI, an electronic health record-derived behavioral marker, can be used to target interventions to patients with clinically significant nonadherence. ClinicalTrials.Gov, NCT03691220