Table 2.

General characteristics of the included studies

Source, author, year, country	Participants	Sample Size (n)	Intervention	Duration	Outcomes	Results	Effect	Conclusion
Christina Freier et al., Germany [31]	Adolescents following transplantation	IG (26) CG (24)	Educational programme using the OTIS system (computer systems)	24 months	(1) Process outcome (IRK and IRB) (2) Clinical outcome (GFR)	(1) Overall IRK improved significantly over time (p < 0.0001) for IGr patients relative to CGr. Analysis of IRK demonstrated a significant increase in knowledge from T0 to T1 (p < 0.028) and from T1 to T2 (p < 0.045) in the IGr when compared to the CGr. With respect to IRB (2) The GFR gradient was stable in the IGr relative to a significant decrease in the CGr (p < 0.001)	(1) Positive effect (2) No effect	The results presented this medium holds the potential to improve perceived IRK and behavior. Moreover, this medium can support the challenging transition period from pediatric to adult care
Robinson et al., United States [36]	Kidney transplant recipient	IG (84) CG (86)	Educational tablet program (Smartphones/software)	2 weeks	(1) Process outcome (knowledge) (2) Process outcome (Recognize personal skin cancer risk) (3) Process outcome [Willingness to change sun protection (20–100 scale)] (4) Process outcome (sun-protection use) (5) Process outcome (Daily hours outdoors (0.5–6 h)	(1) The increase in knowledge of Hispanic Latino kidney transplant recipients was significantly greater than the increase in knowledge by non-Hispanic white and non-ispanic black kidney transplant recipients (p < .05) (2) Recognize personal skin cancer risk (1–5 scale) (3) The greatest willingness to change sun protection was demonstrated by Hispanic Latino kidney transplant recipients (p < .05) (4) use of sun protection increased from baseline to 2 weeks after the program in participants from all ethnic/racial groups in comparison with controls (p < 0.05) (4) Daily hours outdoors [0.5–6 h (p value = 0.01)]	(1) Positive effect (2) Positive effect (3) Positive effect (4) Positive effect (5) Positive effect	Kidney transplant recipients from diverse racial/ethnic groups and health literacy levels who used SunProtect became aware of their risk of developing skin cancer, increased their knowledge of skin cancer and sun protection, showed willingness to change their sun rotection, and changed their sun-protection behavior. Educational program with a tablet computer during the kidney transplant recipients’ 6- or 12-month follow-up visits to the transplant nephrologist improved sun protection in all racial/ethnic groups. Tablets may be used to provide patient education and reduce the physician’s burden of educating and training patients
McGillicuddy et al., United States [3]	Kidney transplant recipient	IG (11) CG (10)	mHealth system (include a BP monitoring device + electronic medication tray + a smart phone + text message) (Smartphones or PDA)	3 months	(1) Process outcome (medication adherence) (2) Clinical outcome (systolic blood pressure) (3) Clinical outcome (diastolic blood pressure)	(1) The repeated-measures ANOVA yielded a significant group by time interaction F 3,48 = 11.74, p < 0.001, and a significant main effect for time F 3,48 = 32.81, p < 0.001, 2) (2) A significant group by time interaction was observed for systolic BP (SBP), F 3,51 = 4.33, p = .009 (3) Results for diastolic blood pressure (DBP) also revealed a significant group by time interaction F 3,51 = 4.58, p = 0.006	(1) Positive effect (2) Positive effect (3) Positive effect	Prototype mHealth system was acceptable and resulted in significant improvements in medication adherence and BP control
Gordon et al., United States [33]	Hispanic kidney transplant candidates and their family Members and friends	IG (61) CG(62)	Website (computer systems)	3 weeks	Process outcome (knowledge about LDKT)	Website exposure was associated with a mean 21.7% same day knowledge score increase between pretest and posttest (p < 0.001). At 3 weeks, website participants' knowledge scores remained 22.6% above the pretest; control scores increased to 11.8% (p = 0.0001). Regression results found that website participants were associated with a 10.0% greater knowledge score at 3-week follow-up (p < 0.0001)	Positive effect	Our culturally targeted website increased participants' knowledge about LDKT (living donor kidney transplantations) above and beyond an in-person educational session in Spanish or English
Gordon, United States [34]	Kidney transplant candidate	IG(133) CG(155	Mobile Web application (Inform Me) (Smartphones/software)	3 weeks	(1) Process outcome (Knowledge about increased risk donor Kidney) (2) Process outcome (Willingness to accept increased risk donor kidney)	(1) Intervention participants had higher test 1 knowledge scores (mean difference, 6.61; 95% confidence interval [95% CI], 5.37–7.86) than control participants, representing a 44% higher score than control participants' scores. Intervention participants' knowledge scores increased with educational reinforcement (test 2) compared with control arm test 1 scores (mean difference, 9.50; 95% CI, 8.27–10.73). After 1 week, intervention participants' knowledge remained greater than controls' knowledge (mean difference, 3.63; 95% CI, 2.49–4.78) (test 3) (2) Willingness to accept an increased risk donor kidney did not differ between study arms at tests 1 and 3	(1) Positive effect (2) No effect	Inform Me use was associated with greater knowledge about increased risk donor kidneys above routine transplant education alone
Reese, United States [35]	Kidney transplant recipients	IG1(40) IG2(40) CG(40)	Wireless pill bottles monitoring with customized reminders (including alarms, texts, telephone calls, and/or e-mails) (multi-component system)	26 weeks	(1) Process outcome (bottle-measured tacrolimus adherence) (2) Clinical outcome (tacrolimus whole-blood concentrations)	(1) Mean adherence was 78%, 88%, and 55% in the reminders, reminders-plus-notification, and control arms (p, 0.001 for comparison of each intervention to control) (2) Mean tacrolimus levels were not significantly different between groups	(1) Positive effect (2) No effect	Provider notification and customized reminders appear promising in helping patients achieve better medication adherence, but these strategies require evaluation in trials powered to detect differences in clinical outcomes
Schmid, Germany [22]	Renal transplant recipients	IG (23) CG (23)	Remote telemonitoring And Real-time video consultations with access to significant medical data (multi-component system)	12 month	(1) Process outcome (Unplanned admission rate) (2) Process outcome (Length of unplanned stay) (3) Process outcome (Unplanned inpatient care costs) (4) Clinical outcome (acute Rejection rate) (5) Process outcome (rejection therapy initiation) (6) Clinical outcome [Estimated glomerular filtration rate (eGFR)] (7) Process outcome (Ambulatory care visit rate) (8) Process outcome (Immunosuppressive regimen Adherence) (9) Process outcome (Quality of life) (10) Process outcome (Return to employment)	(1) IG had significantly fewer unplanned admissions [IG (median = 0 admissions, interquartile range [IQR] = 1) versus CG (median = 2 admissions, IQR = 2)] (2) IG (median = 0 days, IQR = 6) versus CG (median = 13 days, IQR = 23) (3) The 23 RTR in the CG were hospitalized 29 times more often and spent 283 days longer in inpatient care, with correspondingly greater costs (4) The CG suffered two graft losses, the IG none (5) Biopsy-proven acute rejection rates were too low for permit comparative analyses (6) Both groups maintained transplant function: the median difference for the change in estimated GFR was + 3.6 mL in IG versus + 0.6 mL in CG (7) Differences in ambulatory care visit rates did not reach statistical significance (IG: median = 43 visits, IQR = 22. CG: median = 45 visits, IQR = 28) (8) The prevalence of nonadherence was 17.4% in the IG versus 56.5% in CG (p = 0.013) (9) The scores differed from the SOCG most significantly at T4 (IG [median = 0, IQR = 0.2] versus CG [median = 0.4, IQR = 0.6], p = 0.004, r = 0.42) (10) The IG returned to full employment soon after discharge, as indicated by their median working time percentages, which remained stable throughout year 1 post-transplant. The CG differed significantly between the baseline assessment (median = 50%, IQR = 100) and month 3 post-transplant (median = 0%, IQR = 50), Z = 2.694, p = 0.006, and did not return to full employment within the first post-transplant year	(1) Positive effect (2) Positive effect (3) Positive effect (4) No effect (5) No effect (6) No effect (7) No effect (8) Positive effect (9) Positive effect (10) Positive effect	This comparative effectiveness research has demonstrated the potential of telemedically supported case management to optimize routine evidence-based post-transplant aftercare and support its application at tertiary care hospitals. It provides a basis for a multicenter randomized trial to verify these outcomes in the medium and long term
Côté et al., Canada [32]	Renal transplant recipients	IG (35) CG (35)	Interactive Web-based sessions hosted by a virtual nurse(computer systems)	6 months	(1) Process outcome (Medication adherence) (2) Process outcome (Self-Efficacy) (3) Process outcome (skills) (4) Process outcome (medication side effects) (5) Process outcome (Self-Perceived General State of Health)	No statistically significant differences between the groups or over time (1) p value = 0.2 (2) p value = 0.37 (3) p value = 0.39 (4) p value = 0.44 (5) p value = 0.38	(1) No effect (2) No effect (3) No effect (4) No effect (5) No effect	This study showed that the Transplant-TAVIE, a Web-based tailored nursing intervention, is acceptable and could constitute an accessible adjunct in support of existing specialized services. However, given that this treatment is life long, it is important to deploy interventions adapted to the different phases of the medication management continuum in order to support these patients more effectively

OTIS organ transplantation information system, IRK illness-related knowledge, IRB illness-related behavior, GFR Glomerular Filtration Rate, eGFR estimated glomerular filtration rate, BP Blood Pressure, mHealth mobile health, LDKT living donor kidney transplant, PDA personal digital assistant