From the Department of Nursing, Faculty of Health Science, Başkent University, Ankara, Türkiye.
Exp Clin Transplant. 2024 Oct;22(Suppl 5):71-77. doi: 10.6002/ect.pedsymp2024.O17.
The most effective treatment for end-stage renal failure is renal transplant. Nonadherence to medication is one of the most important factors in organ rejection and an important problem in pediatric renal transplant and an important cause of graft failure. Adherence is the most important modifiable factor that affects treatment outcomes. Factors such as low education level and socioeconomic level, complexity of the treatment, lack of belief in the effectiveness of the treatment, cost, insufficient education, drug toxicity, and adverse effects negatively affect adherence to treatment. Although medication adherence has been studied in pediatric patients, conflicting results remain on which practices are effective. In this systematic review study, we aimed to determine which interventions are effective in increasing medication adherence in pediatric renal transplant.
We searched for randomized, nonrandomized, and other interventional studies conducted between 1980 and 2024 through PubMed, Cochrane, EBSCO, SCOPUS, Web of Science, and National Thesis Center and TÜBİTAK (TR Index) databases. We searched the following medical subjects headings, which included Turkish science terms: "renal transplantation" AND ("medication" OR "immunosuppressive") AND ("compliance" OR "adherence") AND ("child" or "pediatrics"). We included randomized controlled trials, quasi-experimental, and interventional studies on individuals aged <18 years with only renal transplant or with other solid-organ transplants and immunosuppressive treatment. We also examined references of review studies. PRISMA guide was used in reporting the study.
Our search identified 970 articles, with 10 studies that met the inclusion criteria. Only 1 study included children under the age of 12 years was found to be eligible after quality assessment for systematic review. The intervention in this study was based on the self-management model.
Multicomponent interventions may be useful to improve medication adherence in children with renal transplant.
治疗终末期肾衰竭最有效的方法是肾移植。不遵医嘱是器官排斥反应的最重要因素之一，也是儿科肾移植的一个重要问题，也是移植物失功的一个重要原因。依从性是影响治疗结果的最重要的可改变因素。文化程度和社会经济水平低、治疗方案复杂、对治疗效果缺乏信心、费用、教育不足、药物毒性和不良反应等因素都会对治疗的依从性产生负面影响。尽管已经对儿科患者的用药依从性进行了研究，但哪种方法有效的结果仍存在争议。在本系统评价研究中，我们旨在确定哪些干预措施可有效提高儿科肾移植患者的用药依从性。
我们通过 PubMed、Cochrane、EBSCO、SCOPUS、Web of Science 和 National Thesis Center 以及 TÜBİTAK（TR 索引）数据库，检索了 1980 年至 2024 年期间发表的随机、非随机和其他干预性研究。我们搜索了以下医学主题词，包括土耳其科学术语：“肾移植”和（“药物”或“免疫抑制剂”）和（“依从性”或“依从性”）和（“儿童”或“儿科”）。我们纳入了仅接受肾移植或其他实体器官移植和免疫抑制治疗的年龄<18 岁的个体的随机对照试验、准实验和干预性研究。我们还检查了综述研究的参考文献。本研究报告采用 PRISMA 指南。
我们的搜索共确定了 970 篇文章，经过系统评价的质量评估，只有 10 项研究符合纳入标准。只有 1 项研究发现，在对 10 项研究进行质量评估后，符合纳入标准。这项研究的干预措施基于自我管理模式。
多组分干预措施可能有助于提高肾移植儿童的用药依从性。
