Evaluate the Clinical Benefits of EnvarsusXR in Post Liver Transplant

The main aim of this study is to assess the immunosuppressant adherence, efficacy, and safety in post liver transplant patients converted from twice daily tacro to once daily EnvarsusXR. Tacrolimus trough level, clinical markers of liver disease, HbA1c , eGFR will be assessed at baseline, 1 week, 2 week, 4 week, 3 month and 6 months. Graft rejection will be assessed using routine standard guidelines to identify the cause. All patients post 1 year liver transplant, and within 5 years will be eligible to participate.

The primary hypothesis is that once daily dosing will improve medication adherence in patients randomized to the test arm as compared to the control arm, over a period of 9 months. The clinical efficacy will be assessed by no difference in standard deviation of tacrolimus in the two groups. The secondary hypothesis is that improved medication adherence will lead to improved patient reported quality of life (as assessed by PROMIS-29), and better health outcomes (as assessed by HbA1c, eGFR).

Inclusion criteria

• Patients who are 1 year post liver transplant, but within 5 years of transplant
• Serum Creatinine<= 2.5 mg/dl; AST,ALT, AP and GGT<=2 times ULN
• Patient must be on a stable tacrolimus dose, with tacrolimus trough levels between 5-12 ng/ml for 4 or more weeks before enrolment

Exclusion criteria

• Cognitive impairment which precludes participation
• Projected survival, in the opinion of the provider, of less than three months
• Any other solid organ transplant (kidney or pancreas)
• Use of any drug which is known to interfere with tacrolimus metabolism