Adherence to immunosuppressive medications in solid organ transplant recipients: a narrative review of influencing factors
DOI:
https://doi.org/10.12923/pielxxiw-2026-0023Keywords:
adherence, immunosuppressive medications, influencing factors, solid organ transplant recipientsAbstract
Aim. This review aimed to assess immunosuppressive medication adherence and to identify influencing factors. The analysis of prior studies allowed for the formulation of recommendations concerning intervention strategies and methods to support adherence in transplant recipients.
Material and methods. The search strategy was based on literature review of articles published from 1995 to 2023 in the PubMed. The following Medical Subject Headings (MeSH) terms were used: ‘Adherence’ or ‘Compliance’ or ‘Persistence’; ‘Immunosuppressive medications’; ‘Solid organ transplant recipients’. Articles were considered for review if they aligned with the specified objectives.
Results. A meticulous literature search yielded 99 titles, with 29 manuscripts were eliminated and 70 were selected for analysis. Following consensus, 37 were excluded, leaving 33 manuscripts for review. The analysis highlighted a predominant focus on kidney transplant recipients among adults. Post-transplant periods varied up to 5 years.
Conclusions. Adherence to immunosuppressive therapy is a complex, multifactorial process shaped by sociodemographic, psychological, therapy-related, healthcare system, and cultural factors. Both intentional and unintentional non-adherence remain significant challenges, particularly among high-risk groups such as adolescents. Effective strategies should combine simplified regimens, tailored education, psychosocial support and system-level solutions. Integrating these approaches into routine post-transplant care may enhance adherence and improve long-term outcomes, while future research should address the role of social determinants using standardized methodologies
References
1. Vrijens B, De Geest S, Hughes DA, et al. A new taxonomy for describing and defining adherence to medications. Br. J. Clin. Pharmacol. 2012;73(5):691-705. https://doi.org/10.1111/j.1365-2125.2012.04167.x
2. Denhaerynck K, Dobbels F, Košťálová B, et al. Psychometric properties of the BAASIS: A meta-analysis of individual participant data. Transplantation. 2023;107(8):1795¬1809. https://doi.org/10.1097/TP.0000000000004574
3. Griva K, Neo HLM, Vathsala A. Unintentional and intentional non-adherence to immunosuppressive medications in renal transplant recipients. Int. J. Clin. Pharm. 2018;40(5):1234-1241. https://doi.org/10.1007/s11096-018-0652-6
4. Taj SM, Baghaffar H, Alnajjar DK, et al. Prevalence of non-adherence to immunosuppressive medications in Kidney transplant recipients: barriers and predictors. Ann. Transplant. 2021;26:e928356. https://doi.org/10.12659/AOT.928356
5. Ghods AJ, Nasrollahzadeh D. Noncompliance with immunnosuppressive medications after renal transplantation. Exp. Clin. Transplant. 2003;1(1):39-47.
6. Siddaway AP, Wood AM, Hedges LV. How to Do a systematic review: A best practice guide for conducting and reporting narrative reviews, meta-analyses, and meta-syntheses. Annu. Rev. Psychol. 2019;70:747-770. https://doi.org/10.1146/annurev¬psych-010418-102803
7. Moradi O, Karimzadeh I, Davani-Davari D, et al. Pattern and associated factors of adherence to immunosuppressive medications in kidney transplant recipients at a referral center in Iran. Patient Prefer. Adherence. 2019;13:729-738. https://doi.org/10.2147/ppa.S198967
8. Ganjali R, Ghorban Sabbagh M, Nazemiyan F, et al. Factors associated with adherence to immunosuppressive therapy and barriers in asian Kidney transplant recipients. Immunotargets Ther. 2019;8:53-62. https://doi.org/10.2147/itt.S212760
9. Silva AN, Moratelli L, Tavares PL, et al. Self-efficacy beliefs, locus of control, religiosity and non-adherence to immunosuppressive medications in kidney transplant patients. Nephrology (Carlton). 2016;21(11):938-943. https://doi.org/10.1111/nep.12695
10. Shemesh Y, Peles-Bortz A, Peled Y, et al. Feelings of indebtedness and guilt toward donor and immunosuppressive medication adherence among heart transplant (HTx) patients, as assessed in a cross-sectional study with the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS). Clin. Transplant. 2017;31(10). https://doi.org/10.1111/ctr.13053
11. Maximo Silva AC, Sanders-Pinheiro H, Leite RF, et al. Nonadherence to immunosuppressive medications following pediatric kidney transplantation within full cost coverage health system: prevalence and correlates. Exp. Clin. Transplant. 2020;18(5):577-584. https://doi.org/10.6002/ect.2020.0101
12. Griva K, Davenport A, Harrison M, Newman SP. Non-adherence to immunosuppressive medications in kidney transplantation: intent vs. forgetfulness and clinical markers of medication intake. Ann. Behav. Med. 2012;44(1):85-93. https://doi.org/10.1007/s12160-012-9359-4
13. Massey EK, Tielen M, Laging M, et al. Discrepancies between beliefs and behavior: a prospective study into immunosuppressive medication adherence after kidney transplantation. Transplantation. 2015;99(2):375-380. https://doi.org/10.1097/tp.0000000000000608
14. Cossart AR, Staatz CE, Campbell SB, et al. Investigating barriers to immunosuppressant medication adherence in renal transplant patients. Nephrology (Carlton). 2019;24(1):102-110. https://doi.org/10.1111/nep.13214
15. Saravanakumar K, Prakash A, Thopalan B, et al. A study of prevalence and correlates of nonadherence to immunosuppressive medications in renal transplant recipients of South Indian population and their impact on long-term graft function. Saudi J. Kidney Dis. Transpl. 2019;30(3):686-693. https://doi.org/10.4103/1319-2442.261345
16. Cheung CY, Chan KM, Tang G, et al. Immunosuppressive medication adherence in kidney transplant recipients during the COVID-19 pandemic: A cross-sectional study in Hong Kong. Transplant. Proc. 2021;53(8):2447-2450. https://doi.org/10.1016/j.transproceed.2021.08.018
17. Zhu X, Peng B, Yi Q, et al. Prediction Model of immunosuppressive medication non¬adherence for renal transplant patients based on machine learning technology. Front. Med. (Lausanne). 2022;9:796424. https://doi.org/10.3389/fmed.2022.796424
18. Marsicano EO, Fernandes NS, Colugnati FA, et al. Multilevel Correlates of non¬adherence in Kidney transplant patients benefitting from full cost coverage for immunosuppressives: A cross-sectional study. PLoS One. 2015;10(11):e0138869. https://doi.org/10.1371/journal.pone.0138869
19. Zhang P, Zhu X, Yan J, et al. Identification of immunosuppressive medication nonadherence factors through a combined theory model in renal transplant recipients: 6-12. Front. Pharmacol. 2021;12:655836. https://doi.org/10.3389/fphar.2021.655836
20. Zachciał J, Uchmanowicz I, Krajewska M, et al. Adherence to immunosuppressive therapies after kidney transplantation from a biopsychosocial perspective: A cross-sectional study. J. Clin. Med. 2022;11(5). https://doi.org/10.3390/jcm11051381
21. Gorevski E, Succop P, Sachdeva J, et al. Is there an association between immunosuppressant therapy medication adherence and depression, quality of life, and personality traits in the kidney and liver transplant population? Patient Prefer. Adherence. 2013;7:301-307. https://doi.org/10.2147/ppa.S34945
22. Weng FL, Chandwani S, Kurtyka KM, et al. Prevalence and correlates of medication non¬adherence among kidney transplant recipients more than 6 months post-transplant: a cross-sectional study. BMC Nephrol. 2013;14:261. https://doi.org/10.1186/1471-2369-14-261
23. Russell CL, Ashbaugh C, Peace L, et al. Time-in-a-bottle (TIAB): a longitudinal, correlational study of patterns, potential predictors, and outcomes of immunosuppressive medication adherence in adult kidney transplant recipients. Clin. Transplant. 2013;27(5):E580-E590. https://doi.org/10.1111/ctr.12203
24. Tielen M, van Exel J, Laging M, et al. Attitudes to medication after kidney transplantation and their association with medication adherence and graft survival: a 2-year follow-up study. J. Transplant. 2014:2014;675301. https://doi.org/10.1155/2014/675301
25. Teng S, Zhang S, Zhang W et al. Symptom experience associated with immunosuppressive medications in Chinese kidney transplant recipients. J. Nurs. Scholarsh. 2015;47(5):425-434. https://doi.org/10.1111/jnu.12157
26. Kobayashi S, Tsutsui J, Okabe, et al. Medication nonadherence after kidney transplantation: an internet-based survey in Japan. Psychol. Health Med. 2020;25(1):91-101. https://doi.org/10.1080/13548506.2019.1622745
27. Xia M, Yan J, Liu S, et al. Beliefs of immunosuppressive medication among chinese renal transplant recipients, as assessed in a cross-sectional study with the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Transplant. Proc. 2019;51(3):742-748. https://doi.org/10.1016/j.transproceed.2018.10.029
28. Sanders-Pinheiro H, Colugnati FAB, Denhaerynck K, et al. Multilevel correlates of immunosuppressive nonadherence in Kidney transplant patients: the multicenter ADHERE BRAZIL study. Transplantation. 2021;105(1):255-266. https://doi.org/10.1097/tp.0000000000003214
29. Israni AK, Weng FL, Cen YY, et al. Electronically measured adherence to immunosuppressive medications and kidney function after deceased donor kidney transplantation. Clin. Transplant. 2011;25(2):E124-W131. https://doi.org/10.1111/j.1399-0012.2010.01340.x
30. Killian MO. Psychosocial predictors of medication adherence in pediatric heart and lung organ transplantation. Pediatr. Transplant. 2017;21:e12899. https://doi.org/10.1111/petr.12899
31. Denhaerynck K, Berben L, Dobbels F, et al. Multilevel factors are associated with immunosuppressant nonadherence in heart transplant recipients: The international BRIGHT study. Am. J. Transplant. 2018;18(6):1447-1460. https://doi.org/10.1111/ajt.14611
32. Hartono JL, Koh T, Lee GH, et al. Predictors of non-adherence to immunosuppressive therapy in asian liver transplant recipients. Transplant. Proc. 2017;49(6):1419-1424. https://doi.org/10.1016/j.transproceed.2017.02.049
33. Wessels-Bakker MJ, van de Graaf EA, Kwakkel-van Erp JM, et al. The relation between psychological distress and medication adherence in lung transplant candidates and recipients: A cross-sectional study. J. Clin. Nurs. 2022;31(5-6):716-725. https://doi.org/10.1111/jocn.15931
34. Godinas L, Dobbels F, Hulst L, et al. Once daily tacrolimus conversion in lung transplantation: A prospective study on safety and medication adherence. J. Heart. Lung. Transplant. 2021;40(6):467-477. https://doi.org/10.1016/j.healun.2021.02.017
35. Oliveira RA, Turrini RN, Poveda Vde B. Adherence to immunosuppressive therapy following liver transplantation: an integrative review. Rev. Lat. Am. Enfermagem. 2016;24:e2778. https://doi.org/10.1590/1518-8345.1072.2778
36. Marston MT, Berben L, Dobbels F, et al. Prevalence and patient-level correlates of intentional non-adherence to immunosuppressive medication after heart¬transplantation-findings from the international BRIGHT study. Transpl. Int. 2023;36:11308. https://doi.org/10.3389/ti.2023.11308
37. Chisholm MA, Lance CE, Williamson GM, et al. Development and validation of the immunosuppressant therapy adherence instrument (ITAS). Patient. Educ. Couns. 2005;59(1):13-20. https://doi.org/10.1016/j.pec.2004.09.003
38. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med. Care. 1986;24(1):67-74. https://doi.org/10.1097/00005650-198601000-00007
39. Chan AHY, Horne R, Hankins M, et al. The Medication Adherence Report Scale: A measurement tool for eliciting patients’ reports of nonadherence. Br. J. Clin. Pharmacol. 2020;86(7):1281-1288. https://doi.org/10.1111/bcp.14193
40. Myaskovsky L, Jesse MT, Kuntz K, et al. Report from the American Society of Transplantation Psychosocial Community of Practice Adherence Task Force: Real-world options for promoting adherence in adult recipients. Clin. Transplant. 2018;32(9):e13353. https://doi.org/10.1111/ctr.13353
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