Evaluation of the effectiveness of digital health interventions in the postoperative management of lung transplant recipients

To systematically evaluate the effectiveness of digital health interventions (DHIs) in lung transplant recipients and to investigate their impact on quality of life, psychological health, hospital readmission rates, and adherence, thereby providing evidence-based support for postoperative rehabilitation management. This systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines. PubMed, Web of Science, CENTRAL, Scopus, EMBASE, ClinicalTrials.gov, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases were searched from inception to August 2025. Randomized controlled trials (RCTs) involving adult lung transplant recipients were included, in which the intervention group received DHIs and the control group received routine follow-up. Primary outcomes included quality of life (overall SF-36 score), depression and anxiety assessed by the Hospital Anxiety and Depression Scale (HADS), hospital readmission rate, and adherence (self-monitoring, medication adherence, and exercise adherence). Pooled analyses were performed using fixed- or random-effects models as appropriate. Publication bias was assessed using funnel plots and Egger’s test. A total of 11 RCTs involving 1,187 patients were included (610 in the intervention group and 577 in the control group). Compared with routine follow-up, DHIs significantly improved the overall SF-36 score (MD = 3.52, 95% CI 0.61–6.43, P = 0.02), reduced HADS depression scores (MD = − 1.54, 95% CI − 2.23 to − 0.84, P < 0.0001) and anxiety scores (MD = − 1.77, 95% CI − 2.56 to − 0.98, P < 0.0001), and decreased hospital readmission rates (OR = 0.59, 95% CI 0.41–0.83, P = 0.003). Egger’s test indicated potential small-study bias for readmission rates (P = 0.007); however, trim-and-fill analysis identified no missing studies, and the pooled effect estimate remained unchanged. Overall adherence was significantly improved (based on 12 adherence-related outcome measures reported in 9 RCTs; OR = 2.22, 95% CI 1.63–3.02, P < 0.00001), particularly in self-monitoring (OR = 2.15) and medication adherence (OR = 2.48). Exercise adherence showed an improving trend (OR = 1.49) but did not reach statistical significance (P = 0.54). Sensitivity analyses demonstrated robust results. Digital health interventions significantly improve quality of life, alleviate anxiety and depressive symptoms, enhance adherence, and reduce the risk of hospital readmission in lung transplant recipients. Despite the presence of small-study bias and heterogeneity among interventions, the overall findings were robust. DHIs may serve as an important adjunct to postoperative management following lung transplantation. Future multicenter, large-scale, high-quality RCTs with long-term follow-up are warranted to further confirm their effectiveness.