Zhou Lili, Cheng Ke, Chen Linbin, Hou Xinyi, Wan Jingjing
Xiangya College of Nursing, Central South University, Changsha, China.
Department of Transplantation, Xiangya Third Hospital, Central South University, Changsha, China.
J Med Internet Res. 2025 May 13;27:e73520. doi: 10.2196/73520.
As the optimal treatment for end-stage renal disease, kidney transplantation has proven instrumental in enhancing patient survival and quality of life. Suboptimal medication adherence is recognized as an independent risk factor for poor prognosis, graft rejection, and graft loss. In recent years, the advancement of IT has facilitated the integration of eHealth technologies into medical medication management, offering potential solutions to improve patient adherence. However, their efficacy in kidney transplant recipients remains inconclusive.
This study aimed to evaluate the effectiveness of eHealth interventions in improving medication adherence among kidney transplant recipients and identify potential influencing factors.
We systematically searched PubMed, Web of Science, Cochrane Library, Embase, CINAHL, Scopus, and Ovid databases for randomized controlled trials evaluating eHealth interventions targeting immunosuppressant medication adherence in kidney transplant recipients. The search time frame spanned from database inception to November 2024. Two investigators independently screened studies, extracted data, and assessed outcomes. Primary outcomes included adherence measured by self-reported questionnaires, electronic monitoring devices, tacrolimus trough levels, intrapatient variability of tacrolimus concentrations, and the proportion of patients achieving a tacrolimus coefficient of variation <40%. Meta-analyses were performed for dichotomous data and continuous data, while narrative synthesis was applied to single studies or data unsuitable for meta-analysis. Subgroup analyses were conducted to determine whether results differed based on adherence assessment methods, follow-up duration, eHealth functionalities, delivery modes, and intervention designs. Risk of bias and evidence quality were evaluated using the Cochrane Risk of Bias 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation approach, respectively.
A total of 12 studies involving 1234 kidney transplant recipients were included. Significant between-group differences in adherence were observed only when assessed via electronic monitoring devices (risk ratio=1.46, P=.006; mean difference=0.37, P<.001). However, sensitivity analyses using the leave-one-out method demonstrated instability in these findings. Conflicting results or nonsignificant differences (P>.05) were identified across other outcome measures and subgroup analyses.
No definitive conclusions can be drawn regarding the efficacy of eHealth interventions in improving medication adherence among kidney transplant recipients, potentially due to heterogeneity in trial designs, intervention characteristics, user preferences, and variations in adherence definitions and measurement methodologies. These uncertainties are underscored by the low or very low quality of evidence, as assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. While eHealth holds promise, methodological refinements in study design and implementation remain critical. Future research should prioritize high-quality, large-scale evidence to validate its clinical efficacy.
PROSPERO CRD42025640638; https://www.crd.york.ac.uk/PROSPERO/view/CRD42025640638.
作为终末期肾病的最佳治疗方法，肾移植已被证明有助于提高患者生存率和生活质量。次优的药物依从性被认为是预后不良、移植排斥和移植失败的独立危险因素。近年来，信息技术的进步推动了电子健康技术融入医疗药物管理，为提高患者依从性提供了潜在解决方案。然而，它们在肾移植受者中的疗效仍不明确。
本研究旨在评估电子健康干预措施在提高肾移植受者药物依从性方面的有效性，并确定潜在影响因素。
我们系统检索了PubMed、Web of Science、Cochrane图书馆、Embase、CINAHL、Scopus和Ovid数据库，以查找评估针对肾移植受者免疫抑制剂药物依从性的电子健康干预措施的随机对照试验。检索时间范围从数据库建立至2024年11月。两名研究人员独立筛选研究、提取数据并评估结果。主要结局包括通过自我报告问卷、电子监测设备测量的依从性、他克莫司血药谷浓度、他克莫司浓度的患者内变异性，以及他克莫司变异系数<40%的患者比例。对二分数据和连续数据进行荟萃分析，而对单个研究或不适用于荟萃分析的数据进行叙述性综合分析。进行亚组分析以确定结果是否因依从性评估方法、随访持续时间、电子健康功能、交付模式和干预设计而有所不同。分别使用Cochrane偏倚风险2工具和推荐分级、评估、制定与评价方法评估偏倚风险和证据质量。
共纳入12项研究，涉及1234名肾移植受者。仅通过电子监测设备评估时，组间依从性存在显著差异（风险比=1.46，P=0.006；平均差=0.37，P<0.001）。然而，使用留一法进行的敏感性分析表明这些结果不稳定。在其他结局指标和亚组分析中发现了相互矛盾的结果或无显著差异（P>0.05）。
关于电子健康干预措施在提高肾移植受者药物依从性方面的疗效，无法得出明确结论，这可能是由于试验设计、干预特征、用户偏好以及依从性定义和测量方法的差异所致。使用推荐分级、评估、制定与评价方法评估的证据质量低或非常低，凸显了这些不确定性。虽然电子健康有前景，但研究设计和实施方面的方法改进仍然至关重要。未来研究应优先获取高质量、大规模证据以验证其临床疗效。
PROSPERO CRD42025640638；https://www.crd.york.ac.uk/PROSPERO/view/CRD42025640638 。
