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A Systematic Review of Adherence to Immunosuppression among Pediatric Heart Transplant Patients
Keira Nassetta1, Tasmeen Hussain2, Katheryn Gambetta3
1Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL 60611, USA.
Insights
Adherence to immunosuppression medication after pediatric heart transplant is often low, ranging from 40-70%. Poor adherence significantly worsens patient outcomes, highlighting the need for better interventions.
Area of Science:
- Pediatric Cardiology
- Transplant Medicine
- Pharmacology
Background:
- Lifelong immunosuppression is essential for pediatric heart transplant graft survival.
- Current literature lacks a comprehensive review of immunosuppression adherence in this population.
- Understanding adherence patterns is critical for optimizing long-term outcomes.
Purpose of the Study:
- To systematically review and summarize the current literature on adherence to immunosuppression in pediatric heart transplant recipients.
- To identify the prevalence and associated factors of immunosuppression nonadherence.
- To highlight the clinical implications of nonadherence.
Main Methods:
- Systematic literature search conducted in PubMed MEDLINE, Embase, CENTRAL, and Scopus (inception to March 2020).
- Inclusion criteria: studies reporting on immunosuppression adherence with objective or validated adherence measures.
- 14 studies were included after reviewing 880 initial articles.
Main Results:
- Estimated baseline adherence rates varied widely, predominantly between 40% and 70%.
- Immunosuppression nonadherence is linked to adverse outcomes, including graft rejection, hospitalizations, and mortality.
- Nonadherence also correlates with diminished quality of life and mental health challenges.
Conclusions:
- Nonadherence to immunosuppression is a significant and common issue in pediatric heart transplant patients.
- Poor adherence negatively impacts graft survival, overall health, and well-being.
- There is a critical need for developing and evaluating targeted interventions to improve adherence.
Abstract:
After pediatric heart transplant, commitment to lifelong immunosuppression is crucial to maintaining graft health. However, a review of the current literature surrounding adherence to immunosuppression in pediatric heart transplant patients is lacking. This systematic review aims to summarize the current landscape of adherence to immunosuppression in pediatric heart transplant patients. We conducted searches in PubMed MEDLINE, Embase, CENTRAL register of Controlled Trials (Wiley), and Scopus, from inception to March 2020. Studies were eligible if they outlined an aspect of adherence to immunosuppression and the measurement of adherence was performed with an objective or otherwise validated measure of adherence (e.g., drug levels, adherence questionnaires). The titles/abstracts of 880 articles were reviewed. After initial screening, 106 articles underwent full text review. As such, 14 articles were included in the final review. Baseline adherence estimates varied greatly, with most values between 40% and 70%. Nonadherence to immunosuppression is associated with worse outcomes (rejection, hospitalization, mortality), impaired quality of life, and mental health concerns in pediatric heart transplant patients. As nonadherence to immunosuppression is common and associated with worse outcomes, there is a need for further development and evaluation of interventions in this space.
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