Improving Medication-taking After Liver Transplant

Inclusion Criteria: * The patient is between 11-19 years of age at enrollment. * Guardian's consent, child assent (in accordance with each institution's IRB policies). * The patient is prescribed tacrolimus (either brand or generic formulation). * The patient has been seen in the enrolling center's clinic at least once in the last two years. * The patient's SD of tacrolimus was \> 2.0 in the year prior to enrollment, with at least 3 levels present to make this determination. * The patient and at least one guardian speaks English or Spanish at a level that allows her / him to understand the study procedures and consent to the study. Exclusion Criteria: * The patient received a liver transplant less than 1 year prior to enrollment. * The patient has had more than one transplant (including marrow replacement). * The patient has had biopsy-proven rejection within the past six months. * The patient has been diagnosed with Hepatitis C. * The treating physician has instructed the patient not to obtain tacrolimus levels for at least one year in the past year. * The guardian or child (in a developmentally-appropriate manner) do not understand the study procedures. This will be verified by asking both guardian and child to repeat the study procedures. * The patient is only seen for consultation - most or all of the child's routine care is provided at another center (or in a community clinic). * Either the patient or the guardian is actively psychotic or severely disoriented due to a…