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Review
. 2022 Jan 14;15(7):1253-1274.
doi: 10.1093/ckj/sfac017. eCollection 2022 Jul.

Detecting, preventing and treating non-adherence to immunosuppression after kidney transplantation

Ilaria Gandolfini  1 , Alessandra Palmisano  2 , Enrico Fiaccadori  1 , Paolo Cravedi  3 , Umberto Maggiore  1
Affiliations
Review

Detecting, preventing and treating non-adherence to immunosuppression after kidney transplantation

Ilaria Gandolfini et al. Clin Kidney J. .

Abstract

Medication non-adherence (MNA) is a major issue in kidney transplantation and it is associated with increased risk of rejection, allograft loss, patients' death and higher healthcare costs. Despite its crucial importance, it is still unclear what are the best strategies to diagnose, prevent and treat MNA. MNA can be intentional (deliberate refusal to take the medication as prescribed) or unintentional (non-deliberate missing the prescribed medication). Its diagnosis may rely on direct methods, aiming at measuring drug ingestions, or indirect methods that analyse the habits of patients to adhere to correct drug dose (taking adherence) and interval (time adherence). Identifying individual risk factors for MNA may provide the basis for a personalized approach to the treatment of MNA. Randomized control trials performed so far have tested a combination of strategies, such as enhancing medication adherence through the commitment of healthcare personnel involved in drug distribution, the use of electronic reminders, therapy simplification or various multidisciplinary approaches to maximize the correction of individual risk factors. Although most of these approaches reduced MNA in the short-term, the long-term effects on MNA and, more importantly, on clinical outcomes remain unclear. In this review, we provide a critical appraisal of traditional and newer methods for detecting, preventing and treating non-adherence to immunosuppression after kidney transplantation from the perspective of the practising physician.

Keywords: behaviour therapy; drug monitoring; graft rejection; immunosuppressive agents; medication adherence; organ transplantation; patient education; risk factors.

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Figures

FIGURE 1:
FIGURE 1:
Interplay between the five different domains concerning individual risk factors for medical non adherence.
See this image and copyright information in PMC

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