Charles Varnell, Jr. is a faculty member of the Division of Nephrology & Hypertension at Cincinnati Children’s Hospital Medical Center. As the associate medical director for kidney transplantation, his primary clinical and research interest is the optimal care for children and adolescents with a kidney transplant. Adolescents and young adults with a kidney transplant have 3 times the risk of allograft failure than any other age group. Return to dialysis after allograft failure results in a 30-year loss of life expectancy, dramatically decreased quality of life, and care that costs twice as much. Poor adherence to immunosuppression medication in adolescents accounts for nearly half of all allograft losses. Previously, he worked with the multidisciplinary kidney transplant team to develop, test, and implement a complex intervention designed to identify and address patient and caregiver identified barriers to taking immunosuppression medication during routine clinical care. Following implementation of this system, their rejection rate decreased by 50%, a change that has been sustained for nearly 2 years.

Dr. Varnell's research goal as a PEDSnet Scholar is to prepare for the testing, adaptation, and spread of this complex intervention in kidney transplant programs nationally through the Improving Renal Outcomes Collaborative (IROC) - a network-based learning health system of 32 pediatric kidney transplant programs in the United States. The project specific aims are to:

1. Prospectively characterize barriers to IS adherence and their association with future biopsy-proven acute rejection in a large multi-center cohort of kidney transplant recipients in IROC, and
2. Engage stakeholders to identify key intervention adaptations and contextual factors at IROC centers that will influence adaptation and implementation of the adherence promotion system in their program.