Abstract

Remote interventions are increasingly used in transplant medicine but have rarely been rigorously evaluated. We investigated a remote intervention targeting immunosuppressant management in pediatric lung transplant recipients. Patients were recruited from a larger multisite trial if they had a Medication Level Variability Index (MLVI) ≥2.0, indicating worrisome tacrolimus level fluctuation. The manualized intervention included three weekly phone calls and regular follow-up calls. A comparison group included patients who met enrollment criteria after the subprotocol ended. Outcomes were defined before the intent-to-treat analysis. Feasibility was defined as ≥50% of participants completing the weekly calls. MLVI was compared pre- and 180days postenrollment and between intervention and comparison groups. Of 18 eligible patients, 15 enrolled. Seven additional patients served as the comparison. Seventy-five percent of participants completed ≥3 weekly calls; average time on protocol was 257.7days. Average intervention group MLVI was significantly lower (indicating improved blood level stability) at 180days postenrollment (2.9±1.29) compared with pre-enrollment (4.6±2.10), p=.02. At 180days, MLVI decreased by 1.6 points in the intervention group but increased by 0.6 in the comparison group (p=.054). Participants successfully engaged in a long-term remote intervention, and their medication blood levels stabilized. NCT02266888.

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