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

Figures & data

Figure 1 Meta-analysis article screening flowchart.

Figure 2 Summary of meta-analysis regarding to different subgroups.

Note: Weights are from random effects analysis.
Abbreviation: ES, estimated statistics (transformed proportion).

Table 1 Characteristic of original studies

First author	Year	Country	Sample age	Assessment of nonadherence	Patients (n)		Duration of observation (years)	Study design	NOS scores
Kennard^Citation13	1991	USA	Children	Clinical record	35	11	0.5	Cohort	5
Debolt^Citation14	1995	USA	Children and adolescent	Cyclosporine	39	0	4	Cohort	5
Sellers^Citation15	1997	USA	Children and adolescent	Global	57	11	3.7	Cohort	6
Sudan^Citation16	1997	USA	Children and adolescent	Global	23	4	1	Cohort	7
Molmenti^Citation17	1999	USA	Children and adolescent	Cyclosporine	28	11	9	Cohort	7
Lurie^Citation18	2000	USA	Children and adolescent	Global	19	3	9	Cohort	7
Avitzur^Citation1	2004	Canada	Children and adolescent	Global	32	2	1.5	Cohort	7
			Children and adolescent	Cyclosporine	32	8	1.5	Cohort	7
Berquist^Citation19	2006	USA	Adolescent	Clinical record	97	37	10	Cohort	7
			Adolescent	Cyclosporine	27	14	10	Cohort	6
			Adolescent	Tacrolimus	62	23	10	Cohort	7
Annunziato^Citation20	2007	USA	Adolescent	Global	14	4	3	Cohort	7
Bueno^Citation21	2007	Spain	Children	Global	50	5	3.3	Cohort	8
Fredericks^Citation22	2007	USA	Children	Clinical record	38	19	10	Cohort	7
Berquist^Citation23	2008	USA	Adolescent	Clinical record	111	50	5	Cohort	6
			Adolescent	Cyclosporine	38	21	5	Cohort	7
			Adolescent	Tacrolimus	73	29	5	Cohort	6
Fredericks^Citation24	2008	USA	Adolescent	Tacrolimus	25	8	2	Cohort	7
Shemesh^Citation25	2008	USA	Children and adolescent	Tacrolimus	23	6	1	Cohort	7
Stuber^Citation26	2008	USA	Children and adolescent	Tacrolimus	68	26	2	Cohort	7
Venkat^Citation27	2008	USA	Children	Tacrolimus	101	32	5.3	Cohort	8
Miloh^Citation28	2009	USA	Children and adolescent	Clinical record	41	17	2	Cohort	7
Fredericks^Citation29	2010	USA	Children and adolescent	Clinical record	71	40	9.41	Cohort	6
			Children and adolescent	Cyclosporine	71	19	9.41	Cohort	7
			Children and adolescent	Tacrolimus	71	22	9.41	Cohort	5
Bilhartz^Citation30	2015	USA	Adolescent	Tacrolimus	48	16	12	Cohort	7
Fredericks^Citation31	2015	USA	Children and adolescent	Clinical record	45	24	1	Cohort	7
Bahador^Citation32	2015	Iran	Children	Global	112	21	5	Cohort	7
Shemesh^Citation33	2018	USA	Children and adolescent	Global	222	41	10	Cohort	7

Abbreviation: NOS, Newcastle-Ottawa scale.

Table 2 Summary of nonadherence rate

Nonadherence	Transformed proportion	Transformed 95% CI		Estimated nonadherence rate (%)	95% CI
		Lower	Higher		Lower (%)	Higher (%)
Clinical	1.48	1.35	1.60	45	39	51
Global	0.84	0.74	0.94	17	13	21
Cyclosporine	1.34	1.08	1.61	39	26	52
Tacrolimus	1.25	1.16	1.34	34	30	39

Abbreviation: CI, confidence interval.

Table 3 Summary of publication bias (P)

Publication bias	Global	Clinical record	Tacrolimus	Cyclosporine	Overall
Begg’s	0.536	0.548	0.266	0.462	0.248
Egger’s	0.55	0.989	0.423	0.348	0.419

Table 4 Outcome variables assessed in original articles

	Year	Sociodemographic characteristics						Adverse effect			Social psychological factors
		Gender	Race	Age	Family income	Parent education	Health insurance	Rejection	Graft loss	Death	Single parent	Mental health	Parent cohesion	Social function
Kennard^Citation13	1991				×		✓					✓		×
Sudan^Citation16	1997				✓			✓	✓	✓
Sellers^Citation15	1997		×					✓		✓
Molmenti^Citation17	1999							✓	✓	✓
Avitzur^Citation1	2004					✓		✓
Berquist^Citation19	2006	×		✓			✓	✓	✓	✓	✓
Annunziato^Citation20	2007			✓
Fredericks^Citation22	2007							✓					✓	✓
Berquist^Citation23	2008	×		✓			×	✓	✓	✓	✓
Fredericks^Citation24	2008											✓	✓	✓
Stuber^Citation26	2008			✓
Venkat^Citation27	2008							✓
Miloh^Citation28	2009		×					✓			✓
Fredericks^Citation29	2010		×	✓										✓
Bilhartz^Citation30	2015			×				✓					✓
Fredericks^Citation31	2015			✓									✓
Bahador^Citation32	2015
Shemesh^Citation33	2018					✓				✓	✓

Notes:

✓ means significance from original articles of risk factors; × means no significant reports of risk factors. Blank cells indicate no relevant record in original articles.

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