A nurse-led program to improve immunosuppressant medication adherence in adult kidney transplant recipients: a randomized clinical trial

Suboptimal adherence to immunosuppressant therapy remains a leading cause of graft loss among kidney transplant recipients (KTRs). Nurse-led behavioral and health intervention programs have significant potential to improve medication adherence in this group. This study employed a randomized controlled trial (RCT) design to evaluate the efficacy of a nurse-led intervention program based on theory and evidence aimed at improving immunosuppressant medication (IM) adherence in adult KTRs. We recruited 78 adult patients awaiting their first kidney transplant at the Third Xiangya Hospital, Central South University, China. Following block randomization, participants were allocated to either an intervention group, which received a 3-month, nurse-delivered adherence program alongside routine care, or a control group receiving routine care only. Primary and secondary outcomes were assessed at two timepoints: post-intervention (3 months post-transplant) and follow-up (6 months post-transplant). The intervention group showed significantly better outcomes in IM adherence, IM beliefs, and health beliefs regarding IM. Furthermore, a significantly greater decline in serum creatinine (SCr) levels was observed in the intervention group from 3 to 6 months post-transplant (Cohen’s d = 0.481). No adverse events were observed. Our findings indicate that this structured, nurse-led program is an effective non-pharmacological approach to improving IM adherence in KTRs, yielding concurrent benefits for both physiological and psychological well-being. Nurses can lead the implementation of structured adherence programs within transplant care teams, educating and empowering KTRs to effectively manage their medication behaviors. This program embodies holistic care principles by providing a cost-effective, patient-centered management strategy for KTRs. This RCT was retrospectively registered on the Chinese Clinical Trial Registry (ChiCTR2400083449, registered on April 25, 2024).