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Meta-analysis of medical regimen adherence outcomes in pediatric solid organ transplantation
Mary Amanda Dew1, Annette DeVito Dabbs, Larissa Myaskovsky
1Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA. dewma@upmc.edu
Insights
Pediatric organ transplant recipients show varying adherence rates, with clinic appointments being the most common issue. Psychosocial factors like family and child well-being significantly impact adherence, offering targets for interventions.
Area of Science:
- Pediatric Transplantation
- Medical Adherence Research
- Psychosocial Factors in Health
Background:
- Adherence to medical regimens is crucial for pediatric organ transplant recipients to achieve optimal clinical outcomes.
- Existing literature presents conflicting evidence on the prevalence and risk factors associated with post-transplant nonadherence.
Purpose of the Study:
- To conduct a meta-analysis to determine the prevalence of nonadherence in pediatric organ transplant recipients across different regimen areas.
- To identify and quantify the correlation between psychosocial risk factors and nonadherence in this population.
Main Methods:
- A meta-analysis was performed on 61 studies encompassing kidney, liver, heart, and lung/heart-lung transplant recipients.
- Calculated average nonadherence rates for six regimen areas and assessed correlations with potential risk factors.
Main Results:
- Nonadherence to clinic appointments and tests was most prevalent (12.9 cases per 100 patient-years).
- Immunosuppression nonadherence occurred at 6 cases per 100 patient-years; other areas ranged from 0.6 to 8 cases per 100 patient-years.
- Older child age, negative family functioning, and poorer child psychological status correlated with nonadherence (r=0.12-0.18).
Conclusions:
- Established nonadherence rates serve as benchmarks for clinical risk assessment in pediatric transplant patients.
- Identified psychosocial correlates present viable targets for future intervention strategies.
- Further research should aim to enhance nonadherence risk prediction and evaluate intervention effectiveness.
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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