*Purpose: Medication non-adherence (MNA) is a major risk factor for acute rejection and graft loss. It is unclear how medication side effects (SE) and perceived barriers to adherence correlate with MNA in cardiothoracic transplant (txp). The aim of this study was to assess self-reported MNA, SE and barriers to adherence within a contemporary cohort of heart and lung txp recipients.

*Methods: This was a cross-sectional analysis of a random sample of heart and lung txp recipients receiving care within our txp center. After verbal consent, patients completed a survey comprised of validated instruments to gauge MNA, medication SE and barriers to adherence. Univariate non-parametric statistical analyses were utilized to assess significant associations between medication adherence (high, moderate and low) and SE burden.

*Results: A total of 80 patients were included (33 lung and 47 heart). Methods to promote medication adherence were roughly similar between heart and lung patients, with the majority using a pillbox, followed by daily routine, memory, phone alarm and medication sheet (Figure 1). In terms of expectations, more lung txp patients did not expect to have to drink so much water post-txp (24.2% vs 8.5%, p=0.05). While in terms of barriers to adherence, more heart txp recipients felt their work schedules were a significant barrier (10.6% vs 0%, p= 0.05); 18.2% of lungs and 17.0% of hearts self-reported low medication adherence (missing at least several doses of medications per week, p=0.63). Concerning SE, more lung recipients experienced hair loss (mean SE score 1.9 vs 0.4, p= 0.02) and had a trend for more nausea/vomiting (1.8 vs 0.6, p= 0.06) than heart txp recipients. Patients categorized as having high medication adherence were more recent txp recipients than patients that were less adherent, 2.5 years [0.7, 8.8] vs 4.1 years [1.5, 10.8], respectively. There was a significant association between nausea/vomiting and difficulty completing daily errands and medication adherence; patients with low medication adherence had more severe experiences with these issues (p= 0.02 and p= 0.05, respectively).

*Conclusions: Patients experiencing significant SE and those further out from txp were more likely to be non-adherent with their medication regimens. It is important to closely monitor and manage txp recipients experiencing SE to minimize the impact of non-adherence on clinical outcomes.

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