Adherence to medical regimen after pediatric liver transplantation: a systematic review and meta-analysis

PURPOSE: 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. METHODS: 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 I(2)>50 and P<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 P>0.05 were considered to have no publication bias. RESULTS: 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. CONCLUSIONS: 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.