Background
Although adherence to immunosupressive medication after transplantation is important to maximize good clinical outcomes it remains suboptimal and not well-understood. The purpose of this study was to examine intentional and unintentional non-adherence to immunosuppression medication in kidney transplant patients.
Methods
A cross-sectional sample of N = 218 patients [49.6 ± 12.3 years] recruited in London, UK (1999–2002) completed measures of medication beliefs, quality-of-life, depression, and transplantation-specific emotions. Adherence was measured with self-report and serial immunosuppressive assays.
Results
Intentional non-adherence was low (13.8 %) yet 62.4 % admitted unintentional non-adherence and 25.4 % had sub-target immunosuppressive levels. The risk of sub-target serum immunosuppressive levels was greater for patients admitting unintentional non-adherence (OR = 8.4; p = 0.004). Dialysis vintage, doubts about necessity, and lower worry about viability of graft explained R 2 = 16.1 to 36 % of self-report non-adherence. Depression was related only to intentional non-adherence.
Conclusions
Non-adherence is common in kidney transplantation. Efforts to increase adherence should be implemented by targeting necessity beliefs, monitoring depression, and promoting strategies to decrease forgetfulness.