Prospective study on late consequences of subclinical non-compliance with immunosuppressive therapy in renal transplant patients

Am J Transplant. 2004 Sep;4(9):1509-13. doi: 10.1111/j.1600-6143.2004.00537.x.


In this prospective study we compared the incidence of late acute rejections (LAR) and changes in serum-creatinine over time between compliers and noncompliers with immunosuppressive therapy more than 1 year post transplantation and explored the relative contribution of non-compliance and other risk factors in the occurrence of LAR. One hundred and forty-six adult renal transplant recipients were followed during a 5-year period. Patients were interviewed at the beginning of the study and categorized as non-compliers if they admitted to have skipped immunosuppressive medication on a regular basis during the previous 12 months. The occurrence of LAR during the follow-up period was recorded. We identified 22.6% non-compliers of which 21.2% experienced a late acute rejection compared with 8% in the group of compliers at 5 years postinclusion (p < 0.05). Kaplan-Meier survival analysis showed a decreased rejection free time in non-compliers compared with compliers (p = 0.03). Non-compliant patients had a 3.2 higher risk of LAR (Cox regression analysis, p = 0.005). Non-compliers experienced a higher increase in serum-creatinine over time (Linear Mixed Models, p < 0.001). Non-compliance in renal transplant patients more than 1-year post transplantation is associated with an increased risk for LAR and a higher increase in serum-creatinine during the following 5 years.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Creatinine / blood
  • Female
  • Follow-Up Studies
  • Graft Rejection / epidemiology*
  • Histocompatibility Testing
  • Humans
  • Immunosuppression Therapy / psychology*
  • Interviews as Topic
  • Kidney Transplantation / immunology*
  • Kidney Transplantation / mortality
  • Kidney Transplantation / physiology
  • Kidney Transplantation / psychology*
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Survival Analysis
  • Treatment Refusal*


  • Creatinine