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Introduction: 40% of transplant recipients are non-adherent to medications, causing increased risk of rejection and diminished survival. The relationship between adherence measured as Medication Level Variability Index (MLVI) and graft rejection rates in pediatric liver transplant recipients with CF compared to those without CF will be evaluated. We hypothesize that MLVI is higher and rejection rates are lower in subjects with CF.

Methods: Retrospective chart review of pediatric liver transplants performed at the Children’s Hospital of Philadelphia between 1995-2018 identified 9 CF liver transplant recipients and 9 age matched controls. Medication adherence was assessed using MLVI. An unpaired t-test was performed to determine if there was a difference in MLVI between the two groups, and liver biopsy reports were used to determine rates of rejection.

Results: There was no significant difference comparing MLVI for the CF group (M=3.52; SD= 1.66) and non-CF group (M=2.61; SD= 0.75); t(14)=1.42; p=0.18. These results suggest adherence to immunosuppressive medications are not different between CF and non-CF liver transplant recipients. 2 subjects in the CF group (22%) and 3 subjects (33%) in the non-CF group had rejection on liver biopsy, also not significantly different.

Discussion: Although there is a trend toward higher MLVI in CF recipients, small sample size limits statistical difference. MLVI has been associated with increased rate of rejection, however the CF population may differ from this expectation due immune activity from chronic lung inflammation. Further study with a larger cohort may reveal important changes in rejection risks in CF.