A systematic review of immunosuppressant adherence interventions in transplant recipients: Decoding the streetlight effect.
A systematic review of immunosuppressant adherence interventions in transplant recipients: Decoding the streetlight effect.
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DOI：
10.1111/petr.13086
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发表时间：
2018-03
影响因子：
1.3
通讯作者：
Shemesh E
中科院分区：
文献类型：
--
作者：
Duncan S;Annunziato RA;Dunphy C;LaPointe Rudow D;Shneider BL;Shemesh E
免疫抑制药物的不依从性是移植物功能障碍的重要危险因素。为了评估依从性增强干预措施的有效性，我们回顾了实体器官移植受者（所有年龄段）的依从性干预研究。使用以下数据库：PsychINFO、PubMed、Scopus和ScienceDirect，我们确定了41项符合条件的研究。只有3个非随机试验显示对移植结果的客观指标（如排斥反应、肝酶水平、肾功能）可能有积极影响。21项随机对照试验（rct）均未显示移植预后改善。三项研究表明，干预组的不良事件发生率高于对照组，尽管这可能与确定偏差有关。间接测量的依从性改善（如电子监测设备）与移植结果的影响不一致。我们的结论是，到目前为止，依从性干预在改善移植结果方面基本上是无效的。为了改善这一跟踪记录，干预工作可能希望集中在非依从性患者身上（而不是使用方便抽样，这将许多需要干预的患者排除在外），使用直接的依从性措施来指导干预，并采用密集但足够吸引的策略来确保非依从性患者能够参与。
Nonadherence to immunosuppressant medications is an important risk factor for graft dysfunction. To evaluate the effectiveness of adherence-enhancing interventions, we reviewed adherence intervention studies in solid organ transplant recipients (all ages). Using the following databases: PsychINFO, PubMed, Scopus, and ScienceDirect, we identified 41 eligible studies. Only 3 nonrandomized trials showed a possible positive effect on objective indicators of transplant outcomes (such as rejection, liver enzyme levels, kidney function). None of the 21 randomized-controlled trials (RCTs) showed an improvement in transplant outcomes. Three studies showed a higher rate of adverse events in the intervention group as compared with controls, although this may be related to ascertainment bias. Improvement in adherence as measured indirectly (e.g. with electronic monitoring devices) was not aligned with effects on transplant outcomes. We conclude that adherence interventions, to date, have largely been ineffective in improving transplant outcomes. To improve this track record, intervention efforts may wish to concentrate on nonadherent patients (rather than use convenience sampling, which excludes many of the patients who need the intervention), use direct measures of adherence to guide the interventions, and employ strategies that are intensive and yet engaging enough to ensure that nonadherent patients are able to participate.
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影响因子：
5.1
作者：
Annunziato, Rachel A.;Baisley, Margaret C.;Kerkar, Nanda
通讯作者：
Kerkar, Nanda
影响因子：
2.5
作者：
Cukor, Daniel;Ver Halen, Nisha;Salifu, Moro
通讯作者：
Salifu, Moro
影响因子：
2.1
作者：
DeVito Dabbs A;Dew MA;Myers B;Begey A;Hawkins R;Ren D;Dunbar-Jacob J;Oconnell E;McCurry KR
通讯作者：
McCurry KR
DOI：
10.1111/ajt.13701
发表时间：
2016-07
期刊：
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
影响因子：
--
作者：
DeVito Dabbs A;Song MK;Myers BA;Li R;Hawkins RP;Pilewski JM;Bermudez CA;Aubrecht J;Begey A;Connolly M;Alrawashdeh M;Dew MA
通讯作者：
Dew MA
影响因子：
11.5
作者：
Demonceau, Jenny;Ruppar, Todd;Kristanto, Paulus;Hughes, Dyfrig A.;Fargher, Emily;Kardas, Przemyslaw;De Geest, Sabina;Dobbels, Fabienne;Lewek, Pawel;Urquhart, John;Vrijens, Bernard
通讯作者：
Vrijens, Bernard