Meng Xingchu, Gao Wei, Wang Kai, Han Chao, Zhang Wei, Sun Chao
Department of Organ Transplantation, Tianjin First Center Hospital, Tianjin, China,
Patient Prefer Adherence. 2018 Dec 17;13:1-8. doi: 10.2147/PPA.S181195. eCollection 2019.
Adherence to the medical regimen after pediatric liver transplantation is crucial for good clinical outcomes. However, the existing literature provides inconsistent evidence regarding the prevalence of and risk factors for nonadherence to the medical regimen after pediatric liver transplantation. This study aimed to investigate such nonadherence after pediatric liver transplantation and risk factors associated with this nonadherence using findings of reported studies.
The electronic databases of Excerpta Medica, Ovid Technologies, PubMed and WanFang Data were searched using the keywords "adherence", "liver transplant" and "paediatric". Additionally, relevant references cited in related studies were used to obtain original articles. Using 22 original articles, data regarding nonadherence to the medical regimen after pediatric liver transplantation were quantitatively combined, and risk factors associated with nonadherence were qualitatively identified. Average rates of nonadherence in four areas of medical regimens were calculated. The heterogeneity of the included original articles was also analyzed. When >50 and <0.05, a random effects model was used; otherwise, a fixed effects model was used. Moreover, Egger's and Begg's tests were used to evaluate publication bias, if any, and original articles with >0.05 were considered to have no publication bias.
The clinical attendance nonadherence rate was 45% (95% confidence interval [CI]: 39-51), global nonadherence rate was 17% (95% CI: 13-21) and immunosuppression non-adherence rates were 39% (95% CI: 26-52) and 34% (95% CI: 30-39) for cyclosporine and tacrolimus, respectively. Risk factors included older age of the pediatric patient, low family cohesion, poor social functioning, poor mental health and single-parent family.
The nonadherence rate in pediatric liver transplantation is high. Therefore, intervention on the basis of risk factors, such as mental health and family function, may be necessary. Moreover, a standard technique for assessing nonadherence to the medical regimen after pediatric liver transplantation, comprising as many dimensions as possible, is required in order to be more objective and comprehensive when assessing nonadherence.
小儿肝移植术后坚持医疗方案对于良好的临床结局至关重要。然而，现有文献关于小儿肝移植术后不坚持医疗方案的发生率及危险因素提供的证据并不一致。本研究旨在利用已发表研究的结果调查小儿肝移植术后的这种不坚持情况以及与之相关的危险因素。
使用关键词“坚持”“肝移植”和“儿科”检索医学文摘数据库、Ovid技术数据库、PubMed和万方数据。此外，利用相关研究中引用的参考文献获取原始文章。使用22篇原始文章，对小儿肝移植术后不坚持医疗方案的数据进行定量合并，并定性确定与不坚持相关的危险因素。计算医疗方案四个方面的平均不坚持率。还分析了纳入的原始文章的异质性。当I²>50且P<0.05时，使用随机效应模型；否则，使用固定效应模型。此外，使用Egger检验和Begg检验评估是否存在发表偏倚，P>0.05的原始文章被认为无发表偏倚。
临床就诊不坚持率为45%（95%置信区间[CI]：39-51），总体不坚持率为17%（95%CI：13-21），环孢素和他克莫司的免疫抑制不坚持率分别为39%（95%CI：26-52）和34%（95%CI：30-39）。危险因素包括小儿患者年龄较大、家庭凝聚力低、社会功能差、心理健康状况差和单亲家庭。
小儿肝移植中的不坚持率较高。因此，可能有必要基于心理健康和家庭功能等危险因素进行干预。此外，需要一种评估小儿肝移植术后不坚持医疗方案的标准技术，该技术应尽可能涵盖多个维度，以便在评估不坚持情况时更加客观和全面。
