OBJECTIVES: Medication reconciliation (MedRec) is recognised as an important intervention to reduce the burden of medication discrepancies during transitions in care. However, there is inconclusive evidence as to the impact of MedRec at hospital transitions overall, as well as pharmacy-led MedRec services. This review sought to evaluate the impact of pharmacy-led MedRec interventions on medication discrepancies at hospital transitions. METHODS: Six electronic databases, inclusive from inception to December, 2014 were searched. Included studies were published studies in English that compared the effectiveness of pharmacy-led MedRec interventions to usual care, and that aimed to assess medication discrepancies at hospital transitions.       RESULTS: Nineteen studies which involved a total of 15,525 adult patients were included. Eleven studies were randomized controlled trials. Overall, pharmacy-led MedRec intervention usually revealed a trend towards reduction in medication discrepancies, compared with usual care. Seventeen studies involving 18 MedRec interventions targeting (admission, 9; discharge, 4 and multiple transitions, 5) were included in the meta-analysis. Compared with usual care, single MedRec interventions at transitions in care (either admission or discharge) showed a significant reduction of 66% in patients with medication discrepancies (RR 0.34; 95% CI: 0.23 - 0.50) in favour of the intervention. But, there was no difference between groups for interventions targeting multiple transitions (RR 0.88; 95% CI: 0.77 - 1.02). Subgroup analyses confined to RCTs showed that there were no differences for target of transition (admission vs discharge), type of intervention (multifaceted intervention vs medication reconciliation), and setting (single center vs multicenter), nor pharmacists versus pharmacy technicians (non-RCTs only). Importantly, medication discrepancies of higher clinical impact were more easily identified through pharmacy-led interventions. CONCLUSIONS: : Pharmacy-led MedRec interventions were found to be an effective strategy to reduce medication discrepancies, and had a greater impact when conducted at either admission or discharge but were less effective during multiple transitions in care.