E7

Table E7.1. Frequently identified risk factors for noncompliance

Demographic - Younger age group (e.g., adolescent)

- Lower socioeconomic/unemployment

- Distance from transplant center Social - Cost

- Lack of support (friends or family) Transplant related - Number of medications

- Medication schedule

- Medication side effects

- Time from transplant Psychological - Depression

- Behavior problems

Belief pattern - Lack of belief that medication is related to outcome

- Lack of belief in taking care of oneself

Although a lack of knowledge about the medications or the belief that they are ineffective is certainly associated with an increased risk of noncompliance, what is truly striking is that most noncompliant recipients seem to understand the importance of the immunosuppressive medication and the risks associated with stopping the drugs or missing doses. Especially for most noncompliant recipients, it seems unlikely that mere forgetfulness resulted in missed doses, instead there seem to be other powerful motivating forces that are as yet poorly understood. A number of studies have shown that the rate of noncompliance increases over time posttransplant. While this may be due to financial concerns, it may also be that recipients truly feel well and it is harder to take medicine when feeling well, or when taking drugs is the one thing that differentiates them from everyone else.

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