INCIDENCE, DETERMINANTS, AND CONSEQUENCES OF SUBCLINICAL NONCOMPLIANCE WITH IMMUNOSUPPRESSIVE THERAPY IN RENAL-TRANSPLANT RECIPIENTS

In this descriptive cross-sectional study, we investigated the inciden ce, determinants, and consequences of subclinical noncompliance with i mmunosuppressive therapy in 150 adult renal transplant recipients with more than one year posttransplant status. Symptom frequency and sympt om distress, and self-care agency were measured by the Transplant Symp tom Frequency and Symptom Distress Scale, and the Appraisal for Self-C are Agency Scale, respectively. The Long-Term Medication Behavior Self -Efficacy Scale and a renal transplant knowledge questionnaire were de veloped as part of this study to measure perceived self-efficacy and k nowledge of the therapeutic regimen. Demographic variables were also m easured. The incidence of subclinical noncompliance with immunosuppres sive therapy as assessed by interview was 22.3%. Compliers and noncomp liers differed significantly on the variables of marital status (P=0.0 3), situational-operational knowledge (P=0.02), self-care agency (P=0. 03), and perceived self-efficacy related to long-term medication intak e (P=0.048). A logistic regression model using gender, marital status, perceived self-efficacy, self-care agency, knowledge about medication administration and signs of infection, and situational operational kn owledge as predictor variables, revealed a 78.6% correct classificatio n of compliers versus noncompliers and a sensitivity ratio of 95.9%. T here were significantly more acute late rejection episodes (P=0.003) i n the noncompliant group. Graft survival at 5 years in this group was also significantly lower (P=0.03) than the compliant patients. No sign ificant difference was found in terms of the occurrence of chronic rej ection episodes or in terms of patient survival at 5 years. Because no ncompliance is a risk, factor for negative clinical outcome in renal t ransplant recipients, it is of utmost importance to develop interventi on strategies to enhance compliance in this population by using determ inants identified in exploratory studies.