Meta-Analysis of Medical Regimen Adherence Outcomes in Pediatric Solid Organ Transplantation
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BACKGROUND: Adherence to the medical regimen after pediatric organ transplantation is important for maximizing good clinical outcomes. However, the literature provides inconsistent evidence regarding prevalence and risk factors for nonadherence posttransplant. METHODS: A total of 61 studies (30 kidney, 18 liver, 8 heart, 2 lung/heart-lung, and 3 with mixed recipient samples) were included in a meta-analysis. Average rates of nonadherence to six areas of the regimen, and correlations of potential risk factors with nonadherence, were calculated. RESULTS: Across all types of transplantation, nonadherence to clinic appointments and tests was most prevalent, at 12.9 cases per 100 patients per year (PPY). The immunosuppression nonadherence rate was six cases per 100 PPY. Nonadherence to substance use restrictions, diet, exercise, and other healthcare requirements ranged from 0.6 to 8 cases per 100 PPY. Only the rate of nonadherence to clinic appointments and tests varied by transplant type: heart recipients had the lowest rate (4.6 cases per 100 PPY vs. 12.7-18.8 cases per 100 PPY in other recipients). Older age of the child, family functioning (greater parental distress and lower family cohesion), and the child's psychological status (poorer behavioral functioning and greater distress) were among the psychosocial characteristics significantly correlated with poorer adherence. These correlations were small to modest in size (r=0.12-0.18). CONCLUSIONS: These nonadherence rates provide benchmarks for clinicians to use to estimate patient risk. The identified psychosocial correlates of nonadherence are potential targets for intervention. Future studies should focus on improving the prediction of nonadherence risk and on testing interventions to reduce risk.
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Other groups suggested that in addition to medication adherence, other dimensions such as health perception, diet, exercise, and keeping appointments and contact with the transplant center might influence outcome.
“Other groups[41–43] suggested that in addition to medication adherence, other dimensions, such as health perception, diet, exercise, and keeping appointments and contact with the transplant center might influence outcome.”
From Adherence is associated with a favorable outcome after lung transplantation (2019) · cites this paper as [41]
The Methods (Data extraction; page unavailable) identify diet, exercise, and clinic appointments and tests as adherence dimensions beyond medication use. The Discussion (page unavailable) emphasizes the importance of follow-up activities, but the paper does not identify health perception as an adherence dimension or establish that these dimensions influence transplant outcomes. (LLM, conf=0.83)
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- Authors
- Dew, M. A., Dabbs, A. D., Myaskovsky, L., Shyu, S., Shellmer, D. A., DiMartini, A. F., Steel, J., Unruh, M., Switzer, G. E., Shapiro, R., & Greenhouse, J. B.
- Affiliations
- University of Pittsburgh (US)
- Corresponding author
- Dew, Mary Amanda
- ORCID
- Venue
- Transplantation
- Published
- 2009-09-15
- Volume
- 88
- Issue
- 5
- Pages
- 736-746
- ISSN
- 0041-1337 (ISSN-L)
- PMC
- PMC2769559
- OpenAlex
- W2079064447
- Cited by
- 264
- References
- 80
- Citations by year
- 2026: 8 · 2025: 17 · 2024: 17 · 2023: 13 · 2022: 18 · 2021: 19 · 2020: 19 · 2019: 16 · 2018: 20 · 2017: 19 · 2016: 10 · 2015: 21 · 2014: 25 · 2013: 10 · 2012: 11
- FWCI
- 1.53
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Transplantation (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (MH072718, R01MH072718)
- National Institute of Diabetes and Digestive and Kidney Diseases (L40 DK079757)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Health Professions › Speech and Hearing › Adolescent and Pediatric Healthcare
- Health Sciences › Medicine › Transplantation › Organ and Tissue Transplantation Research
- Keywords
- medication adherence, pediatric solid organ transplantation, immunosuppression adherence, psychosocial risk factors, family functioning, parental distress, family cohesion, child psychological distress, behavioral functioning, kidney transplantation, liver transplantation, heart transplantation, lung transplantation
- MeSH terms
- Adolescent, Adult, Age Factors, Child, Child, Preschool, Humans, Immunosuppressive Agents, Infant, Infant, Newborn, Retrospective Studies, Risk, Risk Factors, Organ Transplantation, Treatment Outcome, Medication Adherence
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