Psychological factors associated with medication non-adherence after kidney transplant: a systematic review

Medication non-adherence remains a persistent and critical challenge among kidney transplant recipients, who demonstrate higher rates of non-adherence than other solid organ transplant populations. Given the associated risks of graft rejection, graft loss, and mortality, a clearer synthesis of underlying psychological factors is needed. This systematic review synthesized evidence on psychological factors associated with self-reported medication non-adherence among adult kidney transplant recipients, integrating quantitative and qualitative research to capture patients' perspectives. Following Joanna Briggs Institute guidelines, five electronic databases (Embase, PubMed, PsycINFO, Scopus, and Web of Science) were searched from inception to 5 May 2026. Eligible studies included quantitative and qualitative research involving adult recipients. Methodological quality was appraised using the Mixed Methods Appraisal Tool, and findings were integrated using a convergent integrated approach. Forty-four studies comprising 11,180 participants were included. Non-adherence prevalence ranged from 12.0% to 89.2%. Four overarching themes were identified: psychological distress, perceptions and beliefs, coping strategies, and social-contextual factors. Depressive symptoms and low social support were the most consistent correlates. Qualitative findings highlighted emotional burden, stigma, and regimen complexity as additional barriers. Medication non-adherence is multifactorial and context dependent. Integrating psychosocial screening and patient-reported outcomes into routine transplant care may improve adherence and long-term graft outcomes.