Background: Patients have to take immunosuppressive medication after kidney transplantation to prevent rejection of the graft. This thesis investigated patients’ adherence behaviour and attitudes and beliefs about the immunosuppressive regime. The research questions were (1) What is the rate of nonadherence among our population of kidney transplant recipients and does this change over time? (2) What are the attitudes, beliefs and goals of kidney transplant recipients towards the medication regime? (3) To what extent are these attitudes, beliefs and goals related to nonadherence? (4) To what extent is nonadherence related to graft survival?
Methods: We used different questionnaires and self-reported nonadherence at different time points in young adults (18-25yrs), the elderly (>65 yrs) and in a kidney transplantation cohort of all ages.
Results: Three distinct attitude profiles concerning post-transplant health lifestyle were repeatedly found: (i) patients that were afraid of rejection and therefore take their medication, (ii) patients that feel secure and know they can take good care of this kidney, and (iii) patients who found their appearance important and experience side-effects of the medication. The profiles were not correlated with nonadherence. Patients find themselves capable of taking the medication correct and understand the importance; nevertheless 6 weeks after kidney transplantation 17% were classified as nonadherent, with a significant lower graft survival. The rate of nonadherence increases to 31% at 18 months. Patients who are younger, have a job, have unrealistic beliefs about the graft survival have a higher risk of being nonadherent. Patients who reported low importance of medication adherence as a personal goal were more likely to become nonadherent over time.
Discussion: The self-reported nonadherence levels found in this study so soon after transplantation demonstrate the need for early and continued intervention after kidney transplantation in order to maximize adherence and consequently clinical outcomes. Changes in (unrealistic) beliefs regarding the longevity of the graft may offer a potential target for intervention among nonadherent patients.