Table 1.
Descriptive information for 61 independent studies of nonadherence after pediatric organ transplantation
| Type of organ transplant |
||||||
|---|---|---|---|---|---|---|
| Characteristic | Total | Kidney | Liver | Heart | Lung/Heart-Lung | Mixed Samplea |
| Number of studies | 61 | 30 | 18 | 8 | 2 | 3 |
| Year of earliest publication of any study examining nonadherence outcomes | 1989 | 1989 | 1990 | 1991 | 1993 | 2006 |
| Study location, continent, % | ||||||
| North America | 68.9 | 60.0 | 77.8 | 87.5 | 50.0 | 67.7 |
| Asia | 14.8 | 26.7 | 5.6 | 0.0 | 0.0 | 0.0 |
| Europe | 11.5 | 3.3 | 16.7 | 12.5 | 50.0 | 33.3 |
| Africa | 3.3 | 6.7 | 0.0 | 0.0 | 0.0 | 0.0 |
| South America | 1.6 | 3.3 | 0.0 | 0.0 | 0.0 | 0.0 |
| Total no. of countries represented | 13 | 11 | 5 | 3 | 2 | 2 |
| Total no. of patients studied | 3,834 | 1,930 | 1,313 | 355 | 43 | 193 |
| Sample size: mean (SD) | 63 (78) | 64 (103) | 73 (56) | 44 (13) | 21 (3) | 64 (21) |
| median | 47 | 33 | 59 | 49 | 21 | 75 |
| range | 11–591 | 11–591 | 14–234 | 27–61 | 19–24 | 40–78 |
| Total person years of observation | 11,573 | 5,110 | 4,557 | 1,410 | 67 | 429 |
| Duration of observation or follow-up, years: mean (SD) | 3.5 (2.3) | 3.5 (3.3) | 3.6 (4.2) | 4.1 (3.50) | 1.6 (0.9) | 3.2 (4.7) |
| median | 3.4 | 2.6 | 2.0 | 2.7 | 1.6 | 0.8 |
| range | 0.04–15.1 | 0.04–13.6 | 1.0–15.1 | 1.0–10.0 | 1.0–2.3 | 0.2–8.6 |
| Study sample age distribution,b % | ||||||
| children only | 6.6 | 10.0 | 5.6 | 0.0 | 0.0 | 0.0 |
| adolescents only | 27.9 | 23.3 | 33.3 | 12.5 | 50.0 | 66.7 |
| children & adolescents | 65.6 | 66.7 | 61.1 | 87.5 | 50.0 | 33.3 |
| absolute age rangec | 0 – 24.9 | 0 – 23 | 0 – 21 | 0 – 19 | 4 – 19 | 7 – 24.9 |
| Study design, % cross-sectional/retrospective (vs. prospective) | 85.2 | 86.7 | 88.9 | 87.5 | 50.0 | 66.7 |
| Study quality evaluation, % | ||||||
| Lower (score 0–2) | 65.6 | 66.7 | 66.7 | 75.0 | 0.0 | 66.7 |
| Higher (3–5) | 34.4 | 33.3 | 33.3 | 25.0 | 100.0 | 33.3 |
| Outcomes examined, no. of studies | ||||||
| Immunosuppression nonadherenced | 41 | 18 | 13 | 7 | 1 | 2 |
| Nonadherence to clinic appts. and tests | 10 | 3 | 3 | 4 | 0 | 0 |
| Diet and exercise nonadherence | 3 | 0 | 0 | 2 | 0 | 1 |
| Alcohol and illicit drug use | 6 | 1 | 1 | 1 | 1 | 2 |
| Tobacco use | 4 | 1 | 0 | 1 | 1 | 1 |
| Global nonadherence | 11 | 4 | 2 | 4 | 1 | 0 |
Samples included recipients of either a kidney, liver, heart, lung, or heart-lung transplant; studies did not provide data separately by transplant type.
Studies that focused on specific age groups, or that conducted analyses comparing adolescents to younger children, varied in the cut point used to define adolescence. The largest group (n=11) of the 23 studies using a cut point defined children as aged 10 and adolescents as aged >10. Five studies used age >11 as the cut point and 7 studies used age >12.
See Appendix A for age range of individual studies included in meta-analysis.
Includes 2 studies that did not clearly exclude nonimmunosuppression medications when examining this outcome. These 2 studies were indistinguishable from the remaining studies in their rates of nonadherence in this outcome area. See Appendix A for outcome areas examined in each study included in the meta-analysis.