Evolving Medication Adherence in the Early Post-Kidney Transplant Period: Recipients’ Lived Experiences from a Single-Center Qualitative Study in Taiwan

Yi-Jen Huang,1 Yen-Ming Huang,1– 3 Chien-Chia Chen,4 Shin-Yi Lin,1 Chen-I Kuan5 1Department of Pharmacy, National Taiwan University Hospital, Taipei City, 100229, Taiwan; 2Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei City, 100025, Taiwan; 3School of Pharmacy, College of Medicine, National Taiwan University, Taipei City, 100025, Taiwan; 4Department of Surgery, National Taiwan University Hospital, Taipei City, 100229, Taiwan; 5Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei City, 100025, TaiwanCorrespondence: Chen-I Kuan, Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei City, 100025, Taiwan, Email [email protected]: Medication non-adherence remains a common challenge among kidney transplantation recipients and is associated with graft dysfunction and loss. Although numerous interventions have been proposed, medication-taking is increasingly recognized as a dynamic process shaped by patients’ daily experiences and changing perceptions after transplantation. This study explored how kidney transplant recipients experience and manage immunosuppressive medication adherence over time and identified factors that influence adherence behaviors during recovery.Methods: This qualitative study used a phenomenology-informed thematic analysis to explore kidney transplant recipients’ lived experiences of immunosuppressive medication adherence. Semi-structured face-to-face interviews were conducted with kidney transplant recipients at a medical center in Taiwan between March and July 2022. A dual-sampling strategy recruited participants in the early post-transplant period and recipients more than one-year post-transplant who had experienced adherence challenges. Participants were followed longitudinally beginning shortly after hospital discharge. Contextual information from a mobile communication application used for clinical follow-up was incorporated to support interpretation of adherence-related experiences. Interviews were audio-recorded, transcribed verbatim, and analyzed using data-driven thematic analysis with NVivo software. Reflexive and collaborative coding processes were applied to enhance analytical rigor.Results: Twelve kidney transplant recipients participated in the study. Six themes described the evolving nature of medication adherence. Improved well-being after transplantation reinforced motivation to adhere, as recipients linked medication-taking with maintaining restored health and independence. However, persistent but mild side effects sometimes created uncertainty about treatment. Over time, vigilance toward medication-taking declined as perceived risk of graft rejection decreased. Daily routines and personal beliefs about medications also shaped adherence behaviors. Mobile-based consultation with healthcare professionals provided timely guidance and reassurance.Conclusion: Medication adherence after kidney transplantation is dynamic and influenced by perceptions of health improvement, treatment burden, and evolving beliefs about medication necessity. Phase-specific and patient-centered strategies, including tailored education and accessible consultation support, may help sustain long-term adherence and optimize graft outcomes.Keywords: adherence, kidney, pharmaceutical care, qualitative, time-evolving, transplantation