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

*Methods: This was a cross-sectional analysis of a random sample of heart, lung, kidney, liver, and pancreas txp recipients receiving care at our center. After verbal consent, patients completed a survey comprised of validated instruments to gauge MNA, medication SE burden score, tools used for MA, and barriers to adherence. Multivariable logistic regression with backward elimination was utilized to assess significant associations between MA (high, moderate and low) and SE burden, MA tools, and perceived barriers to adherence.

*Results: A total of 192 txp patients completed the surveys (39 kidney, 2 pancreas, 71 liver, 47 heart and 33 lung recipients). The mean time post-txp was 4.7±5.8 years, with 40% being within a year of txp and 25% within 90-days of txp; 34% self-rated as having high (perfect) MA, while 6% self-rated as low adherence (missing >2 doses per week); this did not significantly differ by organ type. We correlated the domains of medication SE, tools used for MA and barriers to adherence with self-reporting high MA (Table 1). Using only memory to take meds on time was associated with a 48% lower odds of having high MA, while placing meds in a visible place had twice the odds of high adherence. For each year a patient progressed after txp, there was 13% lower odds of reporting high MA (p<0.001). Additionally, each SE burden point reduced the odds of reporting high adherence by 8% (p=0.01). As far as expectations prior to txp, patients who reported being surprised by the number of meds they had to take post-txp were 54% less likely to be adherent (p= 0.026).

*Conclusions: Being further out from txp, having a high medication SE burden, using only memory to take medications and being surprised by the medication burden were significantly associated with reduced MA. Long-term monitoring of SE and re-educating patients about the importance of medication therapy are likely to play an important role in reducing MNA.

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