title: Prevalence, consequences, and determinants of nonadherence in adult renal transplant patients: a literature review.
abstract: This literature review summarizes the evidence on the prevalence, determinants, clinical and economic consequences of nonadherence with immunosuppressive drugs in renal transplant patients. A literature search yielded 38 articles measuring nonadherence by self-report, collateral report, assay, refill prescriptions or electronic monitoring. The weighted mean prevalence of self-reported nonadherence was 28%. Nonadherence is associated with poor clinical outcomes, contributing to 20% of late acute rejection episodes and 16% of the graft losses (weighted means). In addition, nonadherence results in lower lifetime costs because of shorter survival, yet also in a lower number of quality adjusted life years. Consistent determinants of nonadherence were younger age, social isolation, and cognitions (e.g. low self-efficacy, certain health beliefs). Determinants concerning the health care system/team seem to be under-investigated. Because the evidence summarized in this review is based on older immunosuppressive regimens, further research should focus on prevalence, determinants and consequences of nonadherence with newer immunosuppressive regimens.
authors.affiliation: Institute of Nursing Science, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland.
authors.forename: Kris
authors.initials: K
authors.lastname: Denhaerynck
authors.forename: Fabienne
authors.initials: F
authors.lastname: Dobbels
authors.forename: Irina
authors.initials: I
authors.lastname: Cleemput
authors.forename: Ariane
authors.initials: A
authors.lastname: Desmyttere
authors.forename: Petra
authors.initials: P
authors.lastname: Schäfer-Keller
authors.forename: Stefan
authors.initials: S
authors.lastname: Schaub
authors.forename: Sabina
authors.initials: S
authors.lastname: De Geest
mesh_terms: D000328:Adult; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000191:economics / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016896:Treatment Outcome; D016312:Treatment Refusal
chemical_list: D007166:Immunosuppressive Agents