The purpose of this study is to pilot-test a tailored telemetric intervention to improve
adherence to medications in adults who had a liver transplant and are presently non-adherent
(as measured by tacrolimus levels).
Adult patients who received a liver transplant and for whom there are at least 3 tacrolimus
blood levels within the last year are eligible for the study. Patients will be recruited
from amongst the roster of liver transplant recipients treated at the Recanati-Miller
Transplant Institute at Mount Sinai. The intervention will be pilot-tested on up to 15
non-adherent patients. Patients will be identified using an innovative biomarker for
non-adherence-by calculating the degree of fluctuation between individual medication blood
levels. The telemetric intervention (administered via telephone, or interactive video chat
applications such as FaceTime ® or Skype ®) will enable the intervention team (IT) to
address non-adherence from a remote location, using a structured, tailored approach that
accommodates specific patient needs. The approach includes a focus on psychological
- The patient is at least 18 years of age.
- The patient received a liver transplant at least 2 years prior to initiation of the
- The patient is able to provide consent (i.e. is not encephalopathic or does not have
significant cognitive impairment). Consent may be obtained either by phone or in
person (following a script) and is documented by the researcher.
- The patient is prescribed tacrolimus (either brand or generic formulation).
- The patient is not receiving Hepatitis C treatment during the intervention (given
this can affect levels of tacrolimus and adherence behaviors)
- Thee patient has been seen in the liver transplant clinic at least once in the last
- The patient's MLVI value was ≥ 2, with at least 3 levels present to make this
determination. Only tacrolimus levels drawn in the outpatient setting will be
included in SD calculations. Tacrolimus levels in the inpatient setting (i.e. during
a hospitalization) will be excluded.
- The patient speaks English or Spanish at a level that allows him/her to understand
the study procedures and consent to the study.
- The patient received a liver transplant less than 2 years prior to enrollment.
- The patient received a dual transplant (i.e. liver and kidney).
- The treating physician has instructed the patient not to obtain tacrolimus levels for
at least one year in the past year.
- The patient does not understand the study procedures. This will be verified by asking
the patient to repeat the study procedures.
- The patient is actively psychotic or severely disoriented due to any cause, including
hepatic encephalopathy (temporary exclusion) or severe cognitive impairment.
- The patient is not medically stable or is hospitalized (temporary exclusion until