Noncompliance in organ transplant recipients: a literature review

The effectiveness of medical treatment depends not only on the appropriaten ess of the treatment modality but also on the patient's compliance with the intended regimen. The consequences of failing to comply can be damaging an d devastating for the individual patient and his/her family. Noncompliance also leads to waste in two areas: first, a reduction of the potential benef its of therapy, and second, the additional cost of treating the avoidable c onsequent morbidity. A dramatic example of the consequences of noncomplianc e with the treatment regimen concerns patients who have had organ transplan ts: life-long immunosuppression is a prerequisite for good graft function, and noncompliance is often associated with the occurrence of late acute rej ection episodes, graft loss, and death. Here it might be assumed that these patients constitute a highly motivated group, and that compliance would be high. Unfortunately, this is not the case: overall noncompliance rates var y from 20 to 50%. There is no systematic and comprehensive review of the literature on noncom pliance and its consequences in organ transplant patients to date. This ove rview includes literature on heart, liver and kidney transplants in adult a nd paediatric transplant patients and addresses the following issues: preop erative behaviour patterns as predictors of postoperative compliance proble ms, compliance behaviour after transplantation. noncompliance and its relat ionship to organ loss and death, retransplantation outcome after graft loss due to noncompliance, reasons for postoperative noncompliance, and ways to promote compliance.