Electronic Health Interventions Improve Post-Kidney Transplant Medication Adherence

New research is shedding light on the potential utility of electronic health interventions for improving medication adherence and subsequent patient outcomes in kidney transplant recipients.1

Findings from the systematic review and meta-analysis of 8 randomized controlled trials (RCTs) of patients receiving immunosuppressive therapy following kidney transplantation suggest use of electronic health interventions, including mobile apps, electronic pillboxes, text and email reminders, telemedicine case management, and virtual nurse platforms, results in better medication adherence than standard care methods.1

Kidney transplantation is the most sought-after organ transplant in the US. More than 27,000 kidney transplants were performed in 2023, and as of September 2024, nearly 90,000 of the 103,000 people on the national transplant waitlist were seeking a kidney transplant.2 For patients who receive a kidney transplant, long-term immunosuppressive therapy is required to avoid rejection and prolong graft function, with medication non-adherence serving as a primary risk factor for graft loss and death.3

“[Electronic health interventions] represent a dynamic and innovative approach that has the potential to improve healthcare, enhance patient engagement and facilitate access to care,” Gülsüm Zekiye Tuncer, an assistant professor at Dokuz Eylül University, and colleagues wrote.1 “Moreover, electronic health applications can involve patients in managing their health and improve medication adherence.”

Investigators called attention to the importance of evaluating the effectiveness of such interventions, noting that although several systematic reviews and meta-analyses have been conducted to evaluate electronic health interventions in the context of organ transplant recipients, they could not find any meta-analysis studies focusing specifically on kidney transplant recipients.1

To address this gap in research and evaluate the effectiveness of electronic health interventions for improving medication adherence among kidney transplant recipients, investigators examined full-text RCTs of patients receiving immunosuppressive therapy after kidney transplantation from PubMed, Medline, Web of Science, and Scopus databases.1

Studies published between 2014-2024 and published in English were considered for inclusion. Additionally, eligible studies were required to implement interventions aimed at improving adherence to immunosuppressant therapy for ≥3 months. Electronic monitoring, immunosuppressant serum levels, and self-report scales were used to assess adherence.1

The initial search yielded 524 articles, 48 of which were selected for further evaluation. In total, 8 RCTs comprising 863 participants were ultimately selected for inclusion in the analysis. Among the included studies, 3 were conducted in the United States; 1 in Canada; 1 in both the United States and Canada; 2 in Korea; and 1 in Germany.1

The interventions across the 8 studies involved various digital and telehealth tools—including mobile apps, electronic pillboxes, text and email reminders, telemedicine case management, and virtual nurse platforms—to support medication adherence through reminders, monitoring, alerts, and motivational messaging.1

In the studies that included data on adherence rates, there were 483 people in the electronic health intervention group and 405 people in the control group. Investigators’ analysis of dichotomous data revealed medication adherence rates were significantly greater in kidney transplant recipients receiving electronic health intervention (risk ratio, 1.19; 95% CI, 1.06–1.35; P = .01), with no significant heterogeneity observed between studies (Q = 8.69; P = .28; I2 = 19%).1

In the studies that included adherence score data, there were 229 people in the electronic health intervention group and 196 people in the control group. Because of the analysis of continuous data, investigators noted medication adherence scores were significantly increased in kidney transplant recipients receiving electronic health intervention (standard mean difference, 0.17; 95% CI, 0.05–0.29; P = .02). No significant heterogeneity was observed between studies (Q = 0.45; P = .93; I2 = 0%).1

“These findings demonstrate the potential of electronic health technologies in improving kidney transplant recipients' adherence to immunosuppressive therapy,” investigators concluded.1 “The implementation of electronic health interventions may increase the likelihood of improving long-term survival and patient outcomes by facilitating adherence to treatment regimens in transplant recipients.”

References

1. Tuncer GZ, Tuncer M. Effect of eHealth Interventions on Medication Adherence in Kidney Transplant Recipients: Meta-Analysis of Randomised Controlled Trials. Journal of Renal Care. https://doi.org/10.1111/jorc.70015

2. Health Resources and Services Administration. Organ Donation Statistics.. March 2025. Accessed April 8, 2025. https://www.organdonor.gov/learn/organ-donation-statistics

3. Szumilas K, Wilk A, Wiśniewski P, et al. Current Status Regarding Immunosuppressive Treatment in Patients after Renal Transplantation. Int J Mol Sci. doi:10.3390/ijms241210301