[Non compliance predictive factors in renal transplantation]

Currently many authors report a kidney graft survival of 90-95% at one years post-transplantation. The patients' adherence to the immunosuppressive therapy is an important condition for maintaining graft functioning. A review of the medical literature shows that graft survival is significantly worse in non-compliance patients. As a matter of fact, 267 non compliance patients lost their graft of 7206 renal graft recipients. There are usually three different non-compliance profiles in transplantation : 1) 'Accidental non compliers' (47%) identifies those patients who sometimes forget to take the therapy. 2) 'Invulnerables' (28%) are those patients who believe that they do not need to take their immunosuppressive drugs regularly; 3) 'Decisive non compliers' (25%) are those patients who decide what therapy they should take. Many predictive factors have been associated with non compliance: 1) Demographic variables 2) Psychological variables 3) Psychiatric disorders 4) Poor social support 5) Pretransplantation compliance 6) Substance abuse We therefore think that it is particularly useful to identify non compliers before transplantation through psychological screening, in order to increase their compliance by supportive psychological assistance. Unfortunately, these patients tend to avoid specialists' intervention so it is very useful to provide the medical teams with the necessary training to cope with the psychological problems of their patients.