AN ONGOING study, the iMALT (Improving Medication Adherence in Adolescents who had a Liver Transplant) trial, is aiming to improve health outcomes for young liver transplant recipients by tackling the issue of medication non-adherence.
Non-adherence is the leading cause of organ rejection in this population and has long been recognised as a significant barrier to long-term transplant success. The iMALT study is a multisite, longitudinal, randomised controlled trial that uses a novel behavioural intervention guided by an objective biomarker of adherence.
This biomarker, known as the Medication Level Variability Index (MLVI), is calculated using data from patients’ electronic health records. It identifies those at highest risk of non-adherence and helps determine how much support they receive during the intervention. By using the MLVI to guide intervention intensity over time, the study introduces a dynamic, tailored approach that responds to individual patient needs in real time.
Delivered entirely remotely, the intervention is designed to engage a hard-to-reach adolescent population while reducing the burden on families. Structured around the Template for Intervention Description and Replication (TIDieR) guidelines, the programme includes strategies to maximise engagement, limit attrition and ensure consistent delivery across different locations. The intervention’s flexibility also allows for personalisation based on each patient’s biomarker readings, making it a rare example of a truly adaptive behavioural healthcare programme.
This approach may not only improve medication adherence among adolescent liver transplant recipients but also serve as a model for future interventions across chronic conditions. By combining a biomarker-informed framework with remote delivery and personalised care, the iMALT study offers an innovative direction for behavioural health interventions in complex medical populations.
Reference
Tutino R et al. Development of a targeted, telehealth intervention: experiences from the improving medication adherence in adolescents and young adults following a liver transplantation (iMALT) multisite trial. Pediatr Transplant. 2025;29(5):e70109.
