Adherence to Immunosuppressive Therapies after Kidney Transplantation from a Biopsychosocial Perspective: A Cross-Sectional Study

Abstract

Kidney transplantation (KT) is the best method for kidney replacement therapy (KRT) because of patient survival rates and quality of life (QoL). Nowadays, the main cause of graft loss is antibody-mediated rejection. The treatment of humoral injury is difficult with uncertain results and still not firmly established. Therefore, appropriate adherence is crucial to prolong graft and patient survival. This study aims to evaluate the association of transplant patients’ acceptance of illness, symptoms of anxiety and depression, frailty, and QoL with medication adherence in KT recipients. A total of 210 patients after KT completed the surveys. The instruments were distributed during patients’ admission at the clinic by a qualified nurse, who assisted the patients’ in completing the questionnaires. A cross-sectional study of KT recipients 9.45 ± 7.26 years after KT was performed. Patient adherence with medications was assessed using the Adherence to Refills and Medications Scale (ARMS). Explanatory variables were examined with validated instruments, such as the World Health Organization Quality of Life (WHOQoL-BREF) questionnaire, The Mini-Mental State Examination (MMSE), the Acceptance of Illness Scale (AIS), the Hospital Anxiety and Depression Scale (HADS), and the Tilburg Frailty Indicator (TFI) scale, respectively. Simple linear and multiple regression analyses demonstrated the positive correlation between acceptance of illness and adherence to immunosuppressive medications in a patient sample of KT recipients. The other important factor facilitating adherence to medications was linked with physical and environmental dimensions. On the other hand, frail kidney transplant patients were more likely to be non-adherent. In conclusion, identifying contributors to better medication adherence in immunosuppressive therapy is crucial in preventing transplant rejection or graft loss. In the kidney transplant population, the acceptance of illness, selected dimensions of QoL, and demographic variables associated with rural living and vocational education favored adherence behaviors.

Knowledge, attitude, and practice toward postoperative self-management among kidney transplant recipients

“…The participants' favorable attitudes towards kidney transplantation and their adherence to medical advice align with the recognized positive influence of transplantation on patients' quality of life [ 33 , 34 ]. Correspondingly, the acknowledgment of pressure stemming from potential complications resonates with the psychological burden commonly faced by transplant recipients, as indicated by qualitative research [ 35 , 36 ]. The positive attitudes exhibited by patients towards kidney transplantation and their dedication to medical guidance and dietary management signify their recognition of the procedure's benefits, playing a pivotal role in effective post-transplant care.…”

Chronic Active T-Cell Mediated Kidney Rejection as a Clinically Significant Type of Allograft Loss?

“…Kidney transplantation (KT) is the best method for kidney replacement therapy (KRT) because of high patient survival rates and quality of life (QoL) [ 23 ]. Nonetheless this treatment requires immunosuppressive therapy and currently the occurrence of CA TCMR is being associated by the scientists with insufficient immunosuppression [ 24 ].…”

Psychosocial considerations in the combined bariatric surgery and organ transplantation population: a review of the overlapping pathologies and outcomes

“…From a transplantation perspective, nonadherence has been associated with acute rejection, posttransplant infections, decreased graft survival, increased medical costs, and overall mortality. Estimates in kidney transplant patients indicate that 36% of graft loss was associated with nonadherence [55 ▪ ]. Similar to bariatric surgery, psychiatric disorders, such as depression, substance use disorders, or psychosis, if left untreated, can lead to poor adherence to treatment and poorer transplant outcomes [56].…”