A new study has found parental age and education level, type of insurance, and household income are associated with patient outcomes.

The study, published in Pediatric Transplantation, assessed the psychosocial characteristics of parents and caregivers of pediatric liver transplant recipients, which can include patients with Alagille syndrome (ALGS).

“The long-term success or failure of liver transplantation in children rests with both the recipients and their caregivers who are tasked with carrying out the activities essential to maintaining a functioning graft and good health,” the authors wrote. “Our objectives were to characterize patient and caregiver psychosocial factors in a large cohort of patients and determine whether this impacted non-adherence and thereby allograft rejection.”

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The research team performed a retrospective analysis of the medical records of 136 pediatric liver transplant recipients at a single center between January 1, 2012 and December 31, 2015. A licensed social worker conducted a comprehensive psychosocial evaluation using an institution-developed, nonvalidated questionnaire employed in all solid transplant programs at the center.

Read more about ALGS patient education

The medication level variability index (MLVI) was used to determine medication adherence post-transplant, calculated as the standard deviation of 3 or more tacrolimus trough measurements. An MLVI greater than 2 is considered a risk factor for rejection of the graft and mortality.

The results showed that a lower parental education level and a younger parental age were associated with an MLVI greater than 2 at 1 year post-transplant, possibly reflecting deficiencies in health literacy and comprehension of the complex health regimens required for transplant recipients. Furthermore, those with a lower household income and Medicaid insurance were significantly more likely to be nonadherent at 1 year post-transplant.    

The authors recommend that additional educational and financial resources be allocated to patients with these characteristics, which will require a multidisciplinary effort among healthcare providers and social workers.


Sakhuja S, Himes R, Carreker C, et al. Impact of psychosocial factors on medication level variability index and outcomes in pediatric liver transplant recipients. Ped Transpl. Published online October 16, 2022. doi:10.1111/petr.14425