***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background . Despite the importance of adherence to the medical regimen for maximizing health after lung transplantation , no prospect i ve studies report on rates or risk factors for nonadherence in this patient population . Whether adherence levels differ in lung versus other types of transplant recipients is unknown . Methods . A total of 178 lung recipients and a comparison group of 126 heart recipients were enrolled .  Adherence in nine areas was assessed in separate patient and family caregiver interviews 2 , 7 , 12 , 18 , and 24 months posttransplant . Potential risk factors for nonadherence were obtained at the initial assessment . Results . Cumulative incidence rates of persistent nonadherence ( i.e. , nonadherence at ≥2 consecutive assessment s ) were significantly lower ( P<0.05 ) in lung recipients than heart recipients for taking immunosuppressants ( 13 % nonadherent vs. 21 % , respectively ) , diet ( 34 % vs. 56 % ) , and smoking ( 1 % vs. 8 % ) . Lung recipients had significantly higher persistent nonadherence to completing blood work ( 28 % vs. 17 % ) and monitoring blood pressure ( 70 % vs. 59 % ) . They had a high rate of spirometry nonadherence ( 62 % ; not measured in heart recipients ) . The groups did not differ in nonadherence to attending clinic appointments ( 27 % ) , exercise ( 44 % ) , or alcohol limitations ( 7 % ) . In both groups , poor caregiver support and having only public insurance ( e.g. , Medicaid ) increased nonadherence risk in all areas . Conclusions . Lung recipients were neither uniformly better nor worse than heart recipients in adhering to their regimen . Lung recipients have particular difficulty with some home monitoring activities . Strategies to maximize adherence in both groups should build on caregiver support and on strengthening financial re sources for patient healthcare requirements OBJECTIVE Nonadherence to immunosuppressive medication ( IM ) after kidney transplantation is related to poorer patient and graft outcomes ; therefore research into modifiable factors associated with nonadherence is a priority . In this prospect i ve cohort study we investigated whether changes in goal cognitions , illness perceptions , and treatment beliefs were related to self-reported medication adherence six months after kidney transplantation . METHODS Interviews were conducted with patients in the out-patient clinic six weeks ( T1 : n=113 ) and six months ( T2 : n=106 ) after transplantation .  Self-reported adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale ( BAASIS © Interview ) . The  Brief Illness Perceptions Question naire , Beliefs about Medicines Question naire and questions on goal cognitions were also administered at both time points . RESULTS Self-reported nonadherence increased significantly between 6 weeks and 6 months after transplantation from 17 % to 27 % . Importance of medication adherence as a personal goal and self-efficacy to successfully carry out this goal decreased significantly over time . Perceived necessity of immunosuppressive medication was high but significantly decreased over time . Concerns about the medicines were low . There were no significant changes in illness perceptions or concerns over time . An increase in perceived graft longevity ( timeline ) was related to higher likelihood of nonadherence six months post-transplant . Furthermore , younger adult patients were more likely to be nonadherent six months after transplantation . CONCLUSION The self-reported nonadherence levels found in this study so soon after transplantation demonstrate the need for early and continued intervention after kidney transplantation in order to maximise adherence and consequently clinical outcomes . Changes in ( unrealistic ) beliefs regarding the longevity of the graft may offer a potential target for intervention among nonadherent patients Recent scientific work has established both a theoretical basis and strong empirical evidence for a causal impact of social relationships on health . Prospect i ve studies , which control for baseline health status , consistently show increased risk of death among persons with a low quantity , and sometimes low quality , of social relationships . Experimental and quasi-experimental studies of humans and animals also suggest that social isolation is a major risk factor for mortality from widely varying causes . The mechanisms through which social relationships affect health and the factors that promote or inhibit the development and maintenance of social relationships remain to be explored AIMS To explore the predictive value of adherence to their immunosuppressive medication in kidney transplant recipients in the first year after kidney transplantation as a determinant of graft loss and mortality up to 12 years ( prospect i ve analysis ) and its association with sociodemographic and medical factors and social support ( cross-sectional analysis ) . BACKGROUND Poor adherence to their immunosuppressive medication in kidney transplant recipients remains the leading preventable cause of poor patient outcomes . DESIGN Prospect i ve and cross-sectional study . METHODS At baseline , 325 patients 3 - 12 months posttransplantation were invited to participate .  Adherence  was assessed using collateral reports - a combination of patients ' self-evaluation and an estimate by their nephrologist . The patients provided sociodemographic and medical data and completed the End-Stage Renal Disease Symptom Checklist and Multidimensional scale of perceived social support . At follow-up ( average 7·1 years ) , data on patients and graft survival were obtained . All data were collected from 2002 - 2013 . Multinomial regression analysis and Cox regression were performed . RESULTS A total of 297 patients ( 48·1 ( 12·8 ) years , 61·6 % men ) agreed to participate ( response rate 91·4 % ) ; 67·4 % were considered as fully adherent . Poor adherence was associated with higher risk of graft loss and mortality over 12 years . Female sex , higher education , higher perceived side effects of corticosteroids , better perceived cardiac and renal function and higher perceived family social support in the first year posttransplantation were associated with full adherence to immunosuppressive treatment . CONCLUSIONS Patients with poor adherence to the immunosuppressive medication in the first year after kidney transplantation showed increased likelihood of graft loss and death over 12 years compared with the adherent patients BACKGROUND Although poor medical compliance is a major risk factor for morbidity and mortality after heart transplantation , no prospect i ve data are available on rates of noncompliance with each component of the posttransplantation regimen . Little is known about the impact of health history , sociodemographic , or perioperative psychosocial variables on long-term compliance . METHODS Compliance in eight domains was examined in a cohort of 101 heart recipients followed through the first year after transplantation . Patients received detailed interviews at 2 , 7 , and 12 months after transplantation . Additional corroborative information was obtained from family member interviews and nurse evaluations . Potential predictors of noncompliance were obtained from medical record review s and from initial patient interviews . Predictors pertained to cardiac-related history , psychiatric history , sociodemographic variables , and perioperative psychosocial status ( psychologic adaptation , social supports , coping strategies ) . RESULTS Although degree of noncompliance varied across timepoints , rates of persistent noncompliance during the year were as follows : 37 % ( exercise ) ; 34 % ( monitoring blood pressure ) ; 20 % ( medications ) ; 19 % ( smoking ) ; 18 % ( diet ) ; 15 % ( having blood work completed ) ; 9 % ( clinic attendance ) ; and 6 % ( heavy drinking ) . Compliance in most areas worsened significantly ( p < 0.05 ) over time . Background health-related and sociodemographic characteristics showed no significant influence on any area of posttransplantation compliance . Perioperative psychosocial characteristics were strong and significant predictors of noncompliance . CONCLUSIONS Pretransplantation screening for background and demographic variables may have limited utility for compliance outcomes . Strategies to improve compliance should focus on psychosocial risk factors pertaining to early psychologic reactions to transplantation , the quality of family relationships , and patients ' styles of coping . These risk factors are each potentially modifiable through appropriate educational and supportive interventions OBJECTIVE This study prospect ively investigated the relation between pretransplant  assessment of psychiatric diagnosis , coping skills , and social support and outcome measures of survival and health care utilization . METHOD Ninety-four heart transplant patients underwent structured interviews and completed a battery of self-report psychometric tests assessing coping style , health status , and psychosocial supports . Follow-up that ranged from 9 to 56 months after transplant produced a group of 63 survivors and 31 nonsurvivors , who were found to be comparable in terms of pretransplant cardiac status and severity of illness . RESULTS Survival analysis showed that dimensional psychometric measures of coping and social support based on patient self- assessment were the best significant predictors of survival . Considered separately , interview-determined ratings of social support and pretransplant compliance with treatment regimens were also potential predictors . Formal DSM-III-R diagnoses were related specifically to posttransplant hospital utilization ( axis I diagnoses ) and posttransplant health behavior ( axis II diagnoses ) . CONCLUSIONS The data demonstrate the value of multifaceted assessment , since psychiatric diagnosis , coping style , and psychosocial support may contribute differently to prediction of such aspects of outcome as mortality and health care utilization Introduction . There is growing awareness , yet scant prospect i ve evidence that pretransplant ( TX ) psychosocial factors may predict post-TX outcome . We examined which pre-TX psychosocial factors predict post-TX nonadherence with immunosuppression ( NA ) and clinical outcomes in heart , liver , and lung TX . Methodology . We prospect ively followed 141 patients ( 28 heart , 61 liver , and 52 lung ) from pre-TX until 1 year post-TX . Multivariable analyses determined which pre-TX factors ( i.e. , anxiety , depression , personality traits , social support , adherence with medication , and smoking status ) predict poor post-TX outcome ( i.e. , NA , late acute rejection , graft loss , and re source utilization ) , controlling for medical predictors of poor outcome . Results . Pre-TX self-reported medication nonadherence ( odds ratio [OR]=7.9 ) , lower received social support ( OR=0.9 ) , a higher education ( OR=2.7 ) , and lower “ conscientiousness ” ( OR=0.8 ) were independent predictors of post-TX NA . Not living in a stable relationship predicted graft loss ( OR=4.9 ) . Pre-TX medication NA was the only predictor for presence of late acute rejection ( OR=4.4 ) . No other pre-TX predictors for poor outcome could be found . Conclusion . This is the first prospect i ve study demonstrating that selected pre-TX psychosocial factors predict post-TX NA and poor clinical outcome , implying that pre-TX screening should include this set of factors in addition to traditional medical criteria 
    Output:
    
Among high quality studies , neither social support nor marital status was predictive of medication adherence or post-transplant outcomes .
Social support was not associated with medication adherence .
It was associated with superior post-transplant outcomes , but the relationship was not significant among high quality studies .
Compared to unmarried recipients , married recipients were more likely to adhere to medication post-transplant , but this relationship was not significant among high quality studies .
Marital status was not significantly associated with transplant success .
Social support is weakly and inconsistently associated with post-transplant adherence and outcomes .