Prevalence, consequences, and determinants of nonadherence in adult renal transplant patients: a literature review
Abstract
This literature review summarizes the evidence on the prevalence, determinants, clinical and economic consequences of nonadherence with immunosuppressive drugs in renal transplant patients. A literature search yielded 38 articles measuring nonadherence by self-report, collateral report, assay, refill prescriptions or electronic monitoring. The weighted mean prevalence of self-reported nonadherence was 28%. Nonadherence is associated with poor clinical outcomes, contributing to 20% of late acute rejection episodes and 16% of the graft losses (weighted means). In addition, nonadherence results in lower lifetime costs because of shorter survival, yet also in a lower number of quality adjusted life years. Consistent determinants of nonadherence were younger age, social isolation, and cognitions (e.g. low self-efficacy, certain health beliefs). Determinants concerning the health care system/team seem to be under-investigated. Because the evidence summarized in this review is based on older immunosuppressive regimens, further research should focus on prevalence, determinants and consequences of nonadherence with newer immunosuppressive regimens.
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Increased social isolation was associated with non-adherence to treatment in adult renal transplant patients.
“another found increased social isolation was associated with non-adherence to treatment in adult renal transplant patients 38 .”
From An overview of systematic reviews on the public health consequences of social isolation and loneliness (2017) · cites this paper as [38]
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- Authors
- Denhaerynck, K., Dobbels, F., Cleemput, I., Desmyttere, A., Schafer-Keller, P., Schaub, S., & De Geest, S.
- Affiliations
- University of Basel (CH)
- KU Leuven (BE)
- Belgian Health Care Knowledge Centre (KCE) (BE)
- University Hospital of Basel (CH)
- Venue
- Transplant International
- Publisher
- Frontiers Media SA
- Published
- 2005-10
- Volume
- 18
- Issue
- 10
- Pages
- 1121-1133
- ISSN
- 0934-0874 (ISSN-L)
- 1432-2277
- OpenAlex
- W2151433573
- Cited by
- 424
- References
- 70
- Citations by year
- 2026: 10 · 2025: 11 · 2024: 15 · 2023: 18 · 2022: 28 · 2021: 33 · 2020: 25 · 2019: 30 · 2018: 32 · 2017: 29 · 2016: 26 · 2015: 25 · 2014: 26 · 2013: 15 · 2012: 24
- FWCI
- 0.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Transplant International (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Keywords
- medication non-adherence, kidney transplantation, immunosuppressants, graft loss, acute rejection, economic burden, quality-adjusted life years, self-efficacy, health beliefs, social isolation
- MeSH terms
- Adult, Female, Graft Rejection, Humans, Immunosuppressive Agents, Male, Middle Aged, Prevalence, Kidney Transplantation, Treatment Refusal, Treatment Outcome
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