{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T19:21:44Z","timestamp":1781810504112,"version":"3.54.5"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,11,2]],"date-time":"2022-11-02T00:00:00Z","timestamp":1667347200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Caregivers play an important role in maintaining a functioning graft after pediatric liver transplantation. Therefore, the psychosocial factors of both patients and caregivers can have a critical impact on transplant outcomes. Appropriate assessment and recognition of these factors pre\u2010transplantation may allow transplant teams to better define the needs of pediatric organ recipients and develop specific countermeasures, which may then contribute toward improving transplant outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We studied 136 pediatric LT recipients followed at Texas Children's Hospital. Licensed social workers conducted comprehensive pre\u2010transplant assessments on each patient, consisting of 22 psychosocial variables that were thought to impact adherence, which were reviewed during our study period. Non\u2010adherence was determined using the MLVI for up to 4\u2009years after transplantation. Biopsy\u2010confirmed rejection episodes were assessed in the first 3\u2009years after liver transplantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Factors significantly associated with non\u2010adherence (defined as MLVI &gt;2) included parental age and parental education level at assessment, type of insurance, and household income. The number of ACR episodes trended higher in patients with non\u2010adherence, and these patients had a higher number of moderate to severe rejection episodes but this trend was not statistically significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Psychosocial characteristics such as parental age, education level, insurance, and household income may contribute significantly to suboptimal adherence to medications after transplantation. Identification of these psychosocial factors and early intervention is essential to the success and equitable care of our pediatric LT recipients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.14425","type":"journal-article","created":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T06:29:36Z","timestamp":1667456976000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Impact of psychosocial factors on medication level variability index and outcomes in pediatric liver transplant recipients"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4221-3683","authenticated-orcid":false,"given":"Shruti","family":"Sakhuja","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics Baylor College of Medicine and Texas Children's Hospital Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Himes","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics Baylor College of Medicine and Texas Children's Hospital Houston Texas USA"},{"name":"Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics Ochsner Health New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen","family":"Carreker","sequence":"additional","affiliation":[{"name":"Department of Patient and Family Services Texas Children's Hospital Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Guffey","sequence":"additional","affiliation":[{"name":"Institution for Clinical and Translational Research Baylor College of Medicine Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey","family":"Beer","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics Baylor College of Medicine and Texas Children's Hospital Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mansi","family":"Amin","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics Baylor College of Medicine and Texas Children's Hospital Houston Texas USA"},{"name":"Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics Duke University Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girish","family":"Hiremath","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics Baylor College of Medicine and Texas Children's 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