title: Meta-analysis of medical regimen adherence outcomes in pediatric solid organ transplantation.
abstract: BACKGROUND
  Adherence to the medical regimen after pediatric organ transplantation is important for maximizing good clinical outcomes. However, the literature provides inconsistent evidence regarding prevalence and risk factors for nonadherence posttransplant.
  
  
  METHODS
  A total of 61 studies (30 kidney, 18 liver, 8 heart, 2 lung/heart-lung, and 3 with mixed recipient samples) were included in a meta-analysis. Average rates of nonadherence to six areas of the regimen, and correlations of potential risk factors with nonadherence, were calculated.
  
  
  RESULTS
  Across all types of transplantation, nonadherence to clinic appointments and tests was most prevalent, at 12.9 cases per 100 patients per year (PPY). The immunosuppression nonadherence rate was six cases per 100 PPY. Nonadherence to substance use restrictions, diet, exercise, and other healthcare requirements ranged from 0.6 to 8 cases per 100 PPY. Only the rate of nonadherence to clinic appointments and tests varied by transplant type: heart recipients had the lowest rate (4.6 cases per 100 PPY vs. 12.7-18.8 cases per 100 PPY in other recipients). Older age of the child, family functioning (greater parental distress and lower family cohesion), and the child's psychological status (poorer behavioral functioning and greater distress) were among the psychosocial characteristics significantly correlated with poorer adherence. These correlations were small to modest in size (r=0.12-0.18).
  
  
  CONCLUSIONS
  These nonadherence rates provide benchmarks for clinicians to use to estimate patient risk. The identified psychosocial correlates of nonadherence are potential targets for intervention. Future studies should focus on improving the prediction of nonadherence risk and on testing interventions to reduce risk.
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA. dewma@upmc.edu
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
authors.forename: Annette DeVito
authors.initials: AD
authors.lastname: Dabbs
authors.forename: Larissa
authors.initials: L
authors.lastname: Myaskovsky
authors.forename: Susan
authors.initials: S
authors.lastname: Shyu
authors.forename: Diana A
authors.initials: DA
authors.lastname: Shellmer
authors.forename: Andrea F
authors.initials: AF
authors.lastname: DiMartini
authors.forename: Jennifer
authors.initials: J
authors.lastname: Steel
authors.forename: Mark
authors.initials: M
authors.lastname: Unruh
authors.forename: Galen E
authors.initials: GE
authors.lastname: Switzer
authors.forename: Ron
authors.initials: R
authors.lastname: Shapiro
authors.forename: Joel B
authors.initials: JB
authors.lastname: Greenhouse
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D055118:Medication Adherence; D016377:Organ Transplantation / Q000379:methods*; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents