Effectiveness of Interventions to Increase Medication Adherence in Pediatric Renal Transplant Patients: Systematic Review.

OBJECTIVES

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.

MATERIALS AND METHODS

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.

RESULTS

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.

CONCLUSIONS

Multicomponent interventions may be useful to improve medication adherence in children with renal transplant.