Noncompliance after kidney transplantation: a systematic review

Area of Science:

• Nephrology
• Transplantation Medicine
• Psychology in Medicine

Background:

• Medical noncompliance remains a significant challenge in post-kidney transplantation care.
• Understanding risk factors is essential for improving patient outcomes and graft survival.
• The cyclosporine era presented unique challenges and patient profiles regarding adherence.

Purpose of the Study:

• To systematically review the literature on medical noncompliance following kidney transplantation.
• To identify common characteristics of patients at higher risk for noncompliance.
• To aid clinicians in early intervention strategies for at-risk kidney transplant recipients.

Main Methods:

• Systematic literature review.
• Analysis of studies focusing on medical noncompliance in kidney transplant recipients during the cyclosporine era.
• Identification and synthesis of patient demographics, transplant characteristics, and psychosocial factors associated with noncompliance.

Main Results:

• Higher risk of noncompliance identified in younger, female, unmarried, and non-Caucasian kidney transplant recipients.
• Increased risk also observed in patients receiving living donor transplants, with longer transplant duration, and a history of prior transplantation.
• Psychological factors including anxiety, depression, hostility, distress, poor coping, and avoidant behaviors are significant predictors of noncompliance.

Conclusions:

• Demographic, transplant-related, and psychosocial factors converge to identify high-risk kidney transplant patients for noncompliance.
• Early identification of these risk factors allows for targeted interventions to improve medication adherence and long-term graft survival.
• Addressing emotional and behavioral issues is critical in managing noncompliance in kidney transplant recipients.