Background. Nonadherence to medication is a common problem after kidney transplantation. The aim of this study was to explore attitudes towards medication, adherence, and the relationship with clinical outcomes. Method. Kidney recipients participated in a Q-methodological study 6 weeks after transplantation. As a measure of medication adherence, respondents completed the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS？-interview). Moreover, the intrapatient variability in the pharmacokinetics of tacrolimus was calculated, which measures stability of drug intake. Data on graft survival was retrieved from patient records up to 2 years after transplantation. Results. 113 renal transplant recipients (19–75 years old) participated in the study. Results revealed three attitudes towards medication adherence—attitude 1: “confident and accurate,” attitude 2: “concerned and vigilant,” and attitude 3: “appearance oriented and assertive.” We found association of attitudes with intrapatient variability in pharmacokinetics of tacrolimus, but not with self-reported nonadherence or graft survival. However, self-reported nonadherence immediately after transplantation was associated with lower two-year graft survival. Conclusion. These preliminary findings suggest that nonadherence shortly after kidney transplantation may be a risk factor for lower graft survival in the years to follow. The attitudes to medication were not a risk factor. 1. Introduction Kidney transplant patients are required to take lifelong immunosuppressive medication to prevent graft rejection. Nonadherence to immunosuppressive medication is a common issue and increases over time. Both dosage and timing of medication are crucial. Failure to take the medication as prescribed is a risk factor for (late) acute rejection, (late) graft failure/loss, and patient mortality [1–4]. Among renal transplant patients, on average 36% of patients per year are reported to be nonadherent to immunosuppressive medication with estimates ranging from 2 to 67% [2, 5–7]. A number of patient, practitioner, and regime related factors have been shown to be related to adherence after renal transplantation. The number and frequency of medication, as well as the relationship, communication, and trust between the patient and health care provider, are likely to influence adherence [3]. Nonadherence is particularly a problem among adolescent transplant recipients. Rates of nonadherence have also been found to be related to factors such as level of social support, education, and socioeconomic status [3,
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