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Posttransplant Medical Adherence: What Have We Learned and Can We Do Better?

  • Kidney Transplantation (M Henry and R Pelletier, Section Editors)
  • Published:
Current Transplantation Reports Aims and scope Submit manuscript

Abstract

Purpose of review

Non-adherence to the medical regimen after kidney transplantation can contribute to poor clinical outcomes, and strategies to maximize adherence are sought by care providers and patients alike. We assessed recent evidence on prevalence, risk factors, and clinical outcomes associated with non-adherence to the medical regimen after kidney transplantation. We summarized recent clinical trials testing interventions to improve adherence and generated recommendations for future research and clinical practice.

Recent findings

A large evidence base documents rates of non-adherence to each of the multiple components of the regimen, including medication-taking, lifestyle activities, clinical care requirements, and substance use restrictions. Some risk factors for non-adherence are well known but the full range of risk factors remains unclear. Non-adherence to immunosuppressants and to other components of the regimen increases morbidity and mortality risks. Recent interventions, including education and counseling; electronic health strategies; and medication dose modifications, show promise for reducing immunosuppressant non-adherence. However, most of these interventions would be difficult to deploy in everyday clinical practice. Systematic dissemination of efficacious interventions into clinical practice has not been undertaken.

Summary

Rates and risk factors for non-adherence to the medical regimen have been examined and there is evidence that non-adherence may be ameliorated by a range of interventions. Although gaps in the evidence base remain, it would be timely to devote greater efforts to dissemination of findings. Thus, efforts are needed to assist transplant programs in using existing evidence to better identify patients who are non-adherent and to design and implement strategies to reduce or prevent non-adherence.

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Acknowledgements

Preparation of this report was supported in part by Grants R01 DK101715 and R01 DK110737 from the National Institute of Diabetes and Digestive and Kidney Diseases.

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Authors and Affiliations

  1. Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, 3811 O’Hara Street, Pittsburgh, PA, 15213, USA

    Mary Amanda Dew

  2. Departments of Psychiatry, Psychology, Epidemiology, Biostatistics, and the Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA

    Mary Amanda Dew

  3. Department of Medicine and University of Pittsburgh Medical Center Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA

    Donna M. Posluszny

  4. Departments of Psychiatry and Surgery and the Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA

    Andrea F. DiMartini

  5. Department of Internal Medicine, Nephrology Division, and the Center for Healthcare Equity in Kidney Disease, School of Medicine, University of New Mexico, Albuquerque, NM, USA

    Larissa Myaskovsky

  6. Departments of Surgery, Psychiatry, and Psychology, University of Pittsburgh, Pittsburgh, PA, USA

    Jennifer L. Steel

  7. Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA

    Annette J. DeVito Dabbs

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  1. Mary Amanda Dew
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Correspondence to Mary Amanda Dew.

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Dew, M.A., Posluszny, D.M., DiMartini, A.F. et al. Posttransplant Medical Adherence: What Have We Learned and Can We Do Better?. Curr Transpl Rep 5, 174–188 (2018). https://doi.org/10.1007/s40472-018-0195-8

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