*Purpose: Nonadherence to immunosuppression increases the risk of kidney graft loss. We hypothesized that patient education to self-care dialysis has a positive impact on adherence after transplantation.

*Methods: 201 of 266 incident kidney transplant patients followed up at our institution answered anonymously the BAASIS survey to evaluate adherence to immunosuppressive medication. We retrieved data on demographics, previous dialysis modality, labor condition, comorbidity assessed with the recipient risk score, number of medications and pills, and graft survival during follow-up. Numerical data are expressed in mean and range. We used Chi-square and ANOVA for group comparison, and Cox regression to evaluate the factors affecting graft survival.

*Results: Patient follow-up lasted up to 14 y after transplantation and 5.6 y (0.3-12.7) after the survey. Forty-five grafts were lost during this period. Time from transplantation to the survey was 4.7 y (0.3-9). Age at response was 57 y (23-82) and creatinine 1.5 mg/dl (0.42-5.2) Comorbidity score was 4.1 (1.28-7.0). The number of medications was 11 (3-22) and the number of pills 14.9 (5-40). Before transplantation, 50 patients were on home hemodialysis (HHD), 78 on peritoneal dialysis (PD) and 72 on in-center hemodialysis (icHD). One patient received preemptive transplantation. The BAASIS survey revealed that 96% of previous HHD, 82 % of PD and 83% of ic-HD patients never missed a dose of immunosupressives. However, only 70% of previous HHD, 55% of PD and 75% of ic-HD took their medication on time. No one took drug holidays; only one patient modified the doses. The differences between groups and graft survival between adherent and nonadherent patients were not statistically significant. The Cox model included missing doses, timing, age at response, working vs retired, pill number, previous dialysis modality and comorbidity score. Independent risk factors for graft loss were: missing a dose (HR 3.1, P=0.06); number of pills (HR 1.1 per one pill increase, P<0.001), and comorbidity score (HR 1.5, P=0.02), whereas working (vs. retired) was associated with a lower risk of graft loss (HR 0.22, P=0.001)

*Conclusions: The BAASIS survey alone does not sufficiently identify patients at risk of graft loss. No significant differences were seen in adherence between pretransplant dialysis modalities. However, missing a dose of medication, being retired, a large number of pills and high comorbidity increased the hazards for graft loss.

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