Introduction

Nonadherence to immunosuppressive medication is associated with poor outcomes following kidney transplantation. The aim of this study was to describe the beliefs, understanding and experience of immunosuppressive medication adherence in kidney transplant recipients in order to inform clinical practice in improving immunosuppressive medication adherence in kidney transplant recipients.

Methods

Five focus groups, each including up to 6 kidney transplant recipients were video recorded, transcribed and the content coded. Codes from each focus group were categorised and themes identified.

Results

Participants had a good understanding of the allogenicity of the transplanted organ and the resultant need for lifelong immunosuppressive medication. Missing doses, irregular timing, not taking tacrolimus on an empty stomach and nonattendance at clinic appointments were all defined as nonadherence by the participants. Concern was expressed regarding the risk of adverse effects from immunosuppressive medication, especially when taken in the long term but tended to be balanced against the risk of not taking immunosuppressive medication. Common barriers to adherence identified were forgetfulness, distractions, establishing and maintaining a routine around medicine taking especially in the early post transplant period and pill burden. Self-filled compliance aids, alarms, smart-phone apps, establishing a routine and placing immunosuppressive medication in an obvious place were all popular tools used to improve adherence. Participants felt they had benefitted from support provided by the clinical team in the early post-transplant period but that more medicines adherence support should be provided before and after the transplant and that adherence should be reviewed formally and at regular intervals during clinic appointments.

Conclusion

Although participants understood the need to take immunosuppressive medication a number of barriers were identified that impaired their ability to fully adhere. Barriers to adherence can change over time and participants felt that more formal and regular review of their immunosuppressive medication adherence during clinic appointments would allow the identification of problems at an early stage and facilitate the identification of interventions to help patients maximise their immunosuppressive medication adherence.

CITATION INFORMATION: Goodall D., Willicombe M., McLean A., Taube D. Exploring Immunosuppressant Medication Adherence in Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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