You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.



Medication Noncompliance: Implications for Transplant Professionals

  • Authors: Author: Robert Steiner, MD
Start Activity

Target Audience and Goal Statement

This activity is intended for physicians and other providers who care for solid organ transplant recipients.

The goal of this activity is to describe the problem of medication noncompliance after solid organ transplantation and provide recommendations for prevention of and interventions for this problem with potentially catastrophic consequences.

Upon completion of this activity, participants will be able to:

  1. Identify common reasons for medication noncompliance among solid organ transplant recipients.
  2. Recognize signs and symptoms suggestive of medication noncompliance in the solid organ transplant recipient.
  3. List strategies that the physician can use to help patients be compliant with their immunosuppressive medications.


As an organization accredited by the ACCME, Medscape requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as "financial relationships in any amount, occurring within the past 12 months, that create a conflict of interest."

Medscape encourages Authors to identify investigational products or off-label uses of products regulated by the U.S. Food and Drug Administration, at first mention and where appropriate in the content.


  • Robert Steiner, MD

    Chief, Transplant, Nephrology, University of California San Diego, San Diego, California


    Disclosure: Robert Steiner, MD, has disclosed that he has received grants for clinical research from Wyeth.

Accreditation Statements

    For Physicians

  • Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    Medscape designates this educational activity for a maximum of 1.0 category 1 credit(s) toward the AMA Physician's Recognition Award. Each physician should claim only those credits that reflect the time he/she actually spent in the activity.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.

Follow these steps to earn CME/CE credit:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. Medscape encourages you to complete the Activity Evaluation to provide feedback for future programming.
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 5 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.

The credit that you receive is based on your user profile.


Medication Noncompliance: Implications for Transplant Professionals

Authors: Author: Robert Steiner, MDFaculty and Disclosures



Although significant progress has been made in solid organ transplantation since its beginnings in the 1960s, and particularly during the past 10 years, immunosuppressive drugs must still be taken life-long by solid organ transplant recipients to prevent graft loss caused by acute and chronic rejection. When immunosuppressive regimens were simpler and less effective (ie, prednisone and azathioprine [AZA]), there was perhaps less reason to suspect medication noncompliance as a contributing factor to acute and chronic rejection. In the current era, acute postoperative rejection is uncommon and medication noncompliance has emerged as an increasingly important factor in the ongoing clinical management of organ transplant recipients, having been clearly demonstrated to play a role in acute rejection, chronic rejection, and graft loss.[1]

Although there are other manifestations of noncompliance in transplant recipients (ie, failure to keep scheduled clinic visits or obtain ordered laboratory tests), medication noncompliance is more difficult to recognize and is the most important form of noncompliance in this patient population for several reasons: (1) just as adequate drug exposure in patients who take their medications as prescribed has a positive effect on outcome, limiting drug exposure by failure to take medications altogether has a far more negative effect; (2) detection of potential noncompliance preoperatively should be taken into consideration in the patient evaluation and selection process and trigger initiation of preoperative counseling; (3) the ability to quantify patient noncompliance in drug trials would help separate patient behavioral factors from biologic efficacy; and (4) identification of patients at high risk for noncompliance at any time before or after transplantation should lead to an effective team strategy to minimize its effect on long-term transplant survival.

This review will focus on compliance with medications prescribed to renal transplant recipients. Commonalities that may help clinicians identify patients for early intervention will be discussed. Although many questions remain unanswered, new methodologies, such as electronic pill bottle monitors, provide opportunities to more effectively study medication noncompliance and its risk factors, and offer the potential for earlier intervention and improved outcomes.