Non-adherence to Immunosuppressant after Lung Transplantation – A Common Risk Behavior

Lennerling Annette1, 2, *, Kisch Annika3, 4, Forsberg Anna4, 5
1 Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
2 The Transplant Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
3 Department of Haematology at Skåne University Hospital, Lund, Sweden
4 Institute of Health Sciences at Lund University, Lund, Sweden
5 Department of Thoracic Transplantation and Cardiology, Skåne University Hospital, Lund, Sweden



After lung transplantation, life-long treatment with immunosuppressive medication is required to prevent rejection and graft loss but adherence to immunosuppressive treatment may be difficult for the lung recipient. Adherence is essential and non-adherence to immunosuppressive treatment can lead to graft loss and death.


The aim of this cross-sectional study was to investigate the prevalence of non-adherence 1 to 5 years after lung transplantation in relation to symptom burden, health literacy, psychological well-being and relevant demographic variables.


117 adult lung recipients, due for their annual follow-up 1-5 years after lung transplantation, participated. Four self-report instruments were used for the Basel Assessment of Adherence with Immunosuppressive Medication Scale, the Newest Vital Sign, the Psychological General Well-Being and the Organ Transplant Symptom and Wellbeing Instrument. Statistical analysis was performed.


Thirty percent of the lung recipients were non-adherent. The most common non-adherence dimension was not taking a dose (43%) and not being punctual with the regimen (80%). Of those working full time or part time, 43% were non-adherent (p=.032). A higher level of non-adherence was reported a long time after LuTx with the highest level at the 3-year follow-up.


The level of non-adherence among lung recipients was high. The highest levels were found among those who had returned to work. Non-adherence increased with time after lung transplantation.

Keywords: Lung transplantation, Non-adherence, Symptoms, Health literacy, Well-being, Self-report instruments.

Abstract Information

Identifiers and Pagination:

Year: 2019
Volume: 13
Publisher Item Identifier: EA-TONURSJ-2018-58

Article History:

Received Date: 20/12/2018
Revision Received Date: 27/02/2019
Acceptance Date: 27/03/2019
Electronic publication date: 09/04/2019
Collection year: 2019

© 2019 Annette et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Correspondence: Address correspondence to this author at the Transplant Centre Bruna straket 5, level 6, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden; Tel: +46704149918; E-mail: