Adherence to the immunosuppressive regimen in pediatric kidney transplant recipients: A systematic review
Adherence to the immunosuppressive regimen in pediatric kidney transplant recipients: A systematic review
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DOI：
10.1111/j.1399-3046.2010.01299.x
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发表时间：
2010-08-01
影响因子：
1.3
通讯作者：
Fine, R. N.
中科院分区：
文献类型：
--
作者：
Dobbels, F.;Ruppar, T.;Fine, R. N.
由于之前关于NA的大多数综述都集中在成人移植患者，因此需要对儿科肾移植患者的免疫抑制方案依从性进行全面概述。本系统性综述检索了1990-2008年关于儿童肾移植患者（<21岁）免疫抑制方案中NA的患病率、其后果、决定因素和干预措施的英文文献。我们发现了36篇论文，显示NA的患病率（加权平均值）为31.8%，与年轻患者相比，青少年的风险更高。大约44%的移植物丢失和23%的晚期急性排斥反应与NA有关。大多数研究调查了社会经济、疾病相关或治疗相关的决定因素。只有一项教育干预措施得到了测试，但没有得出结论。免疫抑制方案的NA在儿科肾移植患者中普遍存在严重的临床后果，但尚未探讨经济后果。需要对NA的决定因素进行更多的研究。文献目前缺乏充分把握度的随机对照试验，测试依从性增强干预措施。本系统性综述的结果确定了目前关于NA的循证信息中的差距，并可用作在儿科人群中进行未来依从性研究的工具。
As most prior reviews on NA focus on adult transplant patients, there is a need for a comprehensive overview on adherence to the immunosuppressive regimen in pediatric kidney transplant patients. This systematic review searched for English-language papers (1990-2008) addressing the prevalence of NA to the immunosuppressive regimen, its consequences, determinants, and interventions in pediatric kidney transplant patients (< age 21 yr). We found 36 papers, showing a prevalence of NA (weighted mean) of 31.8% with adolescents being more at risk compared to younger patients. About 44% of all graft losses and 23% of late acute rejection episodes are associated with NA. Most studies investigated socio-economic, condition-related or treatment-related determinants. Only one educational intervention has been tested but yielded inconclusive results. NA to the immunosuppressive regimen is prevalent with serious clinical consequences in pediatric kidney transplant patients, but the economic consequences have not yet been explored. More studies on determinants of NA are needed. The literature currently lacks fully powered RCTs testing adherence-enhancing interventions. The results of this systematic review identify the gaps in the present evidence-based information regarding NA and can be used as a tool to pursue future adherence research in pediatric populations.