Introduction. Non-compliance with immunosuppressants in renal transplant recipients is an important factor affecting graft survival. In the present study, we examined the prevalence of non-compliance, risk factors, as well as the long-term impact of non-compliance on the graft survival after renal transplantation (RT).

Materials and Methods. Non-compliance with medication and follow-up care was retrospectively evaluated in 197 renal transplant recipients (mean age 48.4 ± 14.6 years, 40.6% female, and 86.8% primary graft) with at least 36 months follow-up period. The diagnosis of non-compliance was based on patient self-admission to having discontinued the immunosuppressive drugs as the cause of graft dysfunction (self-report by questionnaires). Long-term graft and patient outcomes in compliant and non-compliant patients were acute rejection (AR) rate and chronic allograft dysfunction (CAD), graft and patient one and three year survival.

Results. The prevalence of non-compliance was 8.1%. Noncompliant patients had more AR episodes (50% vs 24.9%, p = 0.03) and CAD (43.8% vs 21%, p = 0.04). Risk of all cause graft failure in non-compliant group was higher, OR 4.99 (95% CI 1.55–16.08; p = 0.006) compared with compliant group. Graft survival at one and three years was 78.5% and 66.3%, respectively, for compliant patients, while in non-compliant patients 68.8% and 43.7% (Log Rank 7.37; p < 0.006). The risk factors associated with non-compliance were younger age (p = 0.016) and immunosuppressive regimen with the highest number of pills (p = 0.029).

Conclusions. Patients’ compliance with medication and follow-up care after renal transplantation shows long-term clinical benefits. It is of utmost importance to develop intervention strategies to enhance compliance in this population.

Keywords: renal transplantation, compliance, graft and patient outcomes