*Purpose: Non-adherence to immunosuppressant therapy (IST) is one of the major factors leading to graft rejection. To our knowledge, limited data exist on the prevalence of non-adherence in kidney transplant recipients in our institution. Therefore, the study aims to assess the prevalence of non-adherence to IST in our kidney transplant recipients and identify its barriers.

*Methods: We conducted a cross-sectional study from Jan 2017-Nov 2018. We included Kidney transplant recipients who were ≥18 years of age and had a functional kidney. Participants were excluded if they refused to participate or had hospital admission during the administration of the survey or had inactive visits during the study period. The Primary outcome was the prevalence of non-adherence. It was assessed using 1) A telephone-interview from July 2018-Nov 2018 to administer the validated Immunosuppressant Therapy Adherence Instrument Scale (ITAS) survey; the scale ranges (0-12) with higher scores for better adherence, a cut-off value of ≥80% of the score defined adherence. 2) Average serum blood levels of IST (calcineurin inhibitors or sirolimus ) within target therapeutic levels from Jan 2017 to June 2018. Secondary outcomes include barriers for adherence and were assessed using the validated Immunosuppressant Therapy Barriers of Adherence Survey (ITBS); score ranges (13-65), with larger values, indicate high barriers for adherence.

*Results: We enrolled and consented 102 out of 141 patients screened. The mean± SD for age (years), years post-transplant, body mass index (kg/m²) and the baseline of estimated glomerular filtration rate ( ml/min/1.73m² ) were 45.5±15.6, 10.8±6, 29.1± 6 and 72.7±21.9 respectively. We had 66% males, 75% received tacrolimus-based IST. The Prevalence of non-adherence was 5.9% and 14.7% using ITAS survey and the average serum blood therapeutic drug levels, respectively. The concordance for assessing non-adherence between the two methods demonstrated an agreement of 83.4% with a kappa of 0.01, 95% CI (-0.16 to 0.18).The median; Interquartile range for ITBS score, uncontrollable and controllable barriers for adherence were 21;(18-25), 10;(9-13), and 11;(8-13) respectively.

*Conclusions: Our study demonstrated a low to moderate prevalence of non-adherence to IST among kidney transplant recipients based on subjective and objective measures respectively. The barriers for adherence to IST identified warrant further targeted actions to overcome these factors and to optimize therapeutic outcomes. Future studies shall assess the optimum strategies to improve non-adherence in kidney transplant recipients.

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