Medication adherence in renal transplant recipients: A latent variable model of psychosocial and neurocognitive predictors




Paterson, Theone S. E.
O'Rourke, Norm
Shapiro, R. Jean
Thornton, Wendy Loken

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Objective: Estimates indicate that 20-70% of renal transplant recipients are medication non-adherent, significantly increasing the risk of organ rejection. Medication adherence is negatively impacted by lower everyday problem solving ability, and associations between depressive symptoms, self-efficacy, and adherence are reported in renal transplant recipients. Nonetheless, to date, these associations have not been examined concurrently. Given the relationship between non-adherence and organ rejection, it is critical to gain a better understanding of the predictors of adherence in renal transplant recipients. To this end, we modeled relationships among cognitive abilities, depressive symptoms, self-efficacy, and adherence in this group. Methods: Participants (N = 211) underwent renal transplant at least one year prior to participation. Adherence was measured via self-report, medication possession ratio, and immunosuppressant blood-level. Traditionally-measured neurocognitive and everyday problem-solving abilities were assessed. Depressive symptoms were measured via self-report, as were general and medication adherence related self-efficacy. Structural equation modeling was used to assess the fit of the model to available data. Results: Everyday problem solving and self-efficacy had direct positive associations with adherence. Depressive symptoms were negatively associated with self efficacy, but not adherence. Traditionally-measured neurocognitive abilities were positively associated with self-efficacy, and negatively associated with depressive symptoms. Conclusions: We present a comprehensive investigation of relationships between cognitive and psychosocial factors and adherence in medically stable renal transplant recipients. Findings confirm the importance of everyday problem solving and self-efficacy in predicting adherence and suggest that influences of depressive symptoms and neurocognitive abilities are indirect. Findings have important implications for future development of interventions to improve medication adherence in renal transplant recipients.


The authors would like to acknowledge the research assistants and work-study students from the Cognitive Aging Lab at SFU who aided in recruitment and data collection/processing, individuals from the Solid Organ Transplant clinic at Vancouver General Hospital who were involved in any aspect of data collection or liaison with participants, and the participants who took part in this study, for their time commitment, effort, and willingness to participate.


Depression, Renal transplantation, Chronic kidney disease, Medical dialysis, Immunology, Behavior, Psychological and psychosocial issues, Problem solving


Paterson, T. S. E., O’Rourke, N., Shapiro, R. J., & Thornton, W. L. (2018). “Medication adherence in renal transplant recipients: A latent variable model of psychosocial and neurocognitive predictors.” PLoS ONE, 13(9), E0204219. DOI: