Understanding medication nonadherence after kidney transplant

Thomas E. Nevins, Peter W. Nickerson, Mary Amanda Dew

Research output: Contribution to journalReview articlepeer-review

102 Scopus citations


Alloimmunity remains a barrier to long-term graft survival that necessitates lifelong immunosuppressive therapy after renal transplant. Medication nonadherence has been increasingly recognized as a major impediment to achieving effective immunosuppression. Electronic medication monitoring further reveals that nonadherence manifests early after transplant, although the effect is delayed. The etiology of nonadherence ismultifactorial, with the strongest risk factors including past nonadherence and being an adolescent or young adult. Other risk factors with smaller but consistently important effects include minority race/ethnicity, poor social supports, and poor perceived health. In children, risk factors related to parental and child psychologic and behavioral functioning and parental distress and burden are also important. Qualitative systematic reviews highlight the need to tailor interventions to each transplant recipient's unique needs, motivations, and barriers rather than offer a one size fits all approach. To date, relatively fewinterventions have been studied, and most studies conducted were underpowered to allow definitive conclusions. If the kidney transplant community's goal of "one transplant for life" is to become a reality, then solutions for medication nonadherence must be found and implemented.

Original languageEnglish (US)
Pages (from-to)2290-2301
Number of pages12
JournalJournal of the American Society of Nephrology
Issue number8
StatePublished - Aug 2017
Externally publishedYes

Bibliographical note

Publisher Copyright:
Copyright © 2017 by the American Society of Nephrology.


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