*Purpose: Medication non-adherence (M-NA) after renal transplant (RT) increases the risk of graft failure. We conducted a prospective, randomized, single center trial to evaluate 3 strategies combining traditional and novel adherence measures and interventions on M-NA post-RT.

*Methods: 3-9 months post-RT, patients on stable tacrolimus (TAC) doses and able to self-administer medications were randomized (1:1:1) to standard pillbox (G1), electronic pillbox (G2) or electronic pillbox + adherence intervention (G3) over 6 months. Preliminary analyses includes: 1) Self report (Basel Assessment of Adherence Scale for Immunosuppressive [BAASIS^©] questionnaire); 2) TAC concentration variability (TAC CV% = standard deviation/mean) calculated with the 5 prior TAC levels; 3) Electronic pillbox % ON-TIME events (# ON TIME/# total events) for G2-3. Means calculated per time point per group and compared. Funding: AST TIRN grant.

*Results: 45 RT (G1 [16], G2 [14], G3 [14]) recipients enrolled 5/16-11/17. Exclusions: G2 (1subject, TAC stopped), G3 (1 subject analyzed as G1 since no pillbox connectivity). Participants were male (61%), Caucasian (57%), living donor (52%), aged 57 (range 23-76) at RT. Enrollment occurred at 91 (range 75-130) days post RT. Per BAASIS^© 17.8% (53/297) were non-adherent. Self-report remained between 95-99%, appeared to decrease with time for G2. TAC CV% remained < 30% during the study and was similar amongst groups. ON-TIME % of events did not differ amongst G2-3. Figures 1-3 summarize adherence measures per group.

*Conclusions: Active adherence monitoring and coaching is feasible and accepted by RT recipients. We found similar findings amongst groups, but a full analysis including electronic pillbox data and pharmacy records is underway to more completely assess the impact of various monitoring strategies + interventions on M-NA post RT. Identifying RT subgroups that may benefit from adherence interventions may minimize negative outcomes post-RT. Active M-NA interventions may have added benefit over passive alerts/reminders.

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