Immunosuppression non-adherence is one of the leading causes of poor post-transplant outcomes and graft failure. Directly observed therapy (DOT), the practice of watching a patient take every dose of medicine in-person, has been used in treatment settings such as tuberculosis care and led to high rates of medication adherence. Using smartphone video technology, DOT can be performed more broadly and without added burden.


With the support of a Johns Hopkins Discovery Award, the mobile directly observed therapy (mDOT) project was developed to determine the effectiveness of a mobile health solution in helping kidney and liver transplant patients adhere to their medication regimen after discharge. We adapted a smartphone application through which patients film themselves taking their daily medications and healthcare providers confirm accurate medication intake.


We are testing this system through a set of four randomized controlled trials at Johns Hopkins Hospital. Our four patient populations are adult kidney recipients, adult liver recipients, adolescent kidney recipients, and adolescent liver recipients. We aim to compare immunosuppression adherence rates at 3, 6, and 12 months between patients in the study who have access to the smartphone application and those who do not.