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- Derleme MakaleYalnız künye2026Immunosuppressant adherence levels in kidney transplant recipients measured by electronic monitoring devices: A systematic review and meta-analysis
Tuncer, Metin; Yalcinkaya, Turgay; Erol, Ahmet; Özalp, Cemal
Background: Kidney transplantation improves survival and quality of life in patients with end-stage renal disease; however, long-term graft success depends on adherence to immunosuppressive therapy. Objective: To quantify adherence levels among kidney transplant recipients using electronic monitoring devices. Methods: PubMed, Web of Science, Scopus, and the Cochrane Library were systematically searched for studies published between 2000 and 2025. A random-effects meta-analysis was conducted including studies that assessed adherence using electronic monitoring devices. Results: Seven studies with a total of 1025 kidney transplant recipients were included. The pooled mean adherence measured using electronic monitoring devices was 94.39%. In studies with monitoring durations of three months or longer, adherence decreased to 90.50%. Substantial heterogeneity was observed across studies. Conclusion: Although electronically measured adherence appears generally high, its decline over longer monitoring periods indicates that adherence is dynamic and may decrease over time. However, these estimates should be interpreted cautiously because electronic monitoring devices cannot confirm actual medication ingestion. Furthermore, intentionally non-adherent patients may be less likely to participate in or remain engaged with electronic monitoring studies and may therefore be underrepresented, potentially leading to an overestimation of true adherence. Even modest reductions in adherence may carry important clinical consequences, underscoring the need for sustained monitoring.
- MakaleAçık Erişim2025Effect of eHealth Interventions on Medication Adherence in Kidney Transplant Recipients: Meta-Analysis of Randomised Controlled Trials
Tuncer, Metin; Tuncer, Gülsüm Zekiye
Background: Kidney transplant recipients must take immunosuppressive drugs for life, and medication non-adherence is a primary risk factor for graft loss and death. With the advancement of technology, electronic health applications are widely used in chronic disease management and offer the potential to improve medication adherence in kidney transplant recipients. Aim: This meta-analysis aims to evaluate randomised controlled trials (RCTs) that assess the effectiveness of eHealth interventions in improving medication adherence among kidney transplant recipients. Methods: This study, which was designed as a systematic review and meta-analysis, followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocols in the planning and reporting phases. Electronic databases and manual literature searches were the two main data sources. Full-text RCTs in PubMed, Medline, Web of Science and Scopus databases were systematically searched. The searches covered studies from 2014 to March 2024. Results: The search yielded 524 articles. Eight RCTs with 779 participants were included in the analysis. The meta-analysis results indicated that, compared with the control group, adherence rates (RR: 1.19; 95% CI: 1.06–1.35; p = 0.01. Heterogeneity: Q = 8.69; p = 0.28; I2 = 19%) and adherence scores (SMD: 0.17; 95% CI: 0.05–0.29; p = 0.02. Heterogeneity: Q = 0.45; p = 0.93; I2 = 0%) significantly increased in the eHealth intervention group compared with the control group. Conclusion: The findings of this report show that eHealth interventions to improve medication adherence in kidney transplant recipients show favourable outcomes compared with standard care. We recommend eHealth interventions to improve long-term survival and patient outcomes in kidney transplant recipients.
- MakaleAçık Erişim2022Urologists Are No Longer the Primary Surgeons for Several Urologic Operations: A National Survey Among the Turkish Urologists
Madendere, Serdar; Deger, Muslim Dogan; Demirkiran, Engin Denizhan; Yildiz, Huseyin Alperen
Objective: To investigate the role, interest, and competence of the Turkish urologists for urologic surgeries which are also performed by the other surgeons. Materials and Methods: We conducted a 22-item online survey and invited urologists by e-mail. Questions were asked to evaluate the attitudes, performances, and capabilities of the urologists in surgeries which could be performed by the other surgeons. Results: A total of 305 responses were evaluated. The female incontinence surgery, pediatric urologic surgery, and adrenal surgery are mostly performed by the urologists in their hospitals. Turkish urologists mostly do not perform the following surgeries and interventions themselves and refer patients to the other surgeons for a percutaneous nephrostomy (47.2%), urinary diversions using the intestinal segments (44.9%), kidney transplantation (11.8%), and the transgender surgeries (7.2%). Almost half of the urologists do not perform adrenal surgeries (50.2%). Most urologists agree that they should be the main surgeons for all these surgeries. Conclusion: Urologists are no longer the main surgeons for some surgeries which are included on the urologic curriculum. Many urologists avoid performing the major urologic surgeries. Urology educators should familiarize the new urologists with all the urologic surgeries.