Effectiveness of eHealth for Medication Adherence in Renal Transplant Recipients: Systematic Review and Meta-Analysis

Background: As the optimal treatment for end-stage renal disease, kidney transplantation has proven instrumental in enhancing patient survival and quality of life. Suboptimal medication adherence is recognized as an independent risk factor for poor prognosis, graft rejection, and graft loss. In recent years, the advancement of IT has facilitated the integration of eHealth technologies into medical medication management, offering potential solutions to improve patient adherence. However, their efficacy in kidney transplant recipients remains inconclusive. Objective: This study aimed to evaluate the effectiveness of eHealth interventions in improving medication adherence among kidney transplant recipients and identify potential influencing factors. Methods: We systematically searched PubMed, Web of Science, Cochrane Library, Embase, CINAHL, Scopus, and Ovid databases for randomized controlled trials evaluating eHealth interventions targeting immunosuppressant medication adherence in kidney transplant recipients. The search time frame spanned from database inception to November 2024. Two investigators independently screened studies, extracted data, and assessed outcomes. Primary outcomes included adherence measured by self-reported questionnaires, electronic monitoring devices, tacrolimus trough levels, intrapatient variability of tacrolimus concentrations, and the proportion of patients achieving a tacrolimus coefficient of variation <40%. Meta-analyses were performed for dichotomous data and continuous data, while narrative synthesis was applied to single studies or data unsuitable for meta-analysis. Subgroup analyses were conducted to determine whether results differed based on adherence assessment methods, follow-up duration, eHealth functionalities, delivery modes, and intervention designs. Risk of bias and evidence quality were evaluated using the Cochrane Risk of Bias 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation approach, respectively. Results: A total of 12 studies involving 1234 kidney transplant recipients were included. Significant between-group differences in adherence were observed only when assessed via electronic monitoring devices (risk ratio=1.46, P=.006; mean difference=0.37, P<.001). However, sensitivity analyses using the leave-one-out method demonstrated instability in these findings. Conflicting results or nonsignificant differences (P>.05) were identified across other outcome measures and subgroup analyses. Conclusions: No definitive conclusions can be drawn regarding the efficacy of eHealth interventions in improving medication adherence among kidney transplant recipients, potentially due to heterogeneity in trial designs, intervention characteristics, user preferences, and variations in adherence definitions and measurement methodologies. These uncertainties are underscored by the low or very low quality of evidence, as assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. While eHealth holds promise, methodological refinements in study design and implementation remain critical. Future research should prioritize high-quality, large-scale evidence to validate its clinical efficacy.