Please select the eligibility criteria that correspond to the clinical trial below.
Title: Adherence Enhancement for Renal Transplant Patients
Brief Summary: Despite significant advances in the care of kidney transplant recipients, long term graft survival after renal transplantation remains suboptimal. Medication nonadherence and clinical inertia are key contributors to graft loss. The purpose of the proposed RCT feasibility study is to evaluate impact of a "bundled" wireless real time medication reminder system and blood pressure monitoring system in combination with a cognitive behavioral adherence skills enhancement program upon medication adherence, therapeutic drug concentration, and blood pressure, in nonadherent kidney transplant recipients with hypertension. We propose to recruit 60 kidney transplant recipients in phase 1 with 20 non-adherent continuing to phase 2 for a 5-month feasibility RCT.


Options:
A: Inclusion Criteria:

* all patients undergoing solid organ transplantation at Toronto General Hospital during the study period

Exclusion Criteria:

* non-English speaking/reading
* no internet access at home
* planned discharge to a rehab facility without internet access
* not on a calcineurin inhibitor (CNI) or sirolimus
* attending the Self Medication class on the same day as hospital discharge
* cognitive impairment that precludes participation in Self Medication program (as per the assessment of the transplant pharmacist)
* incapable of providing informed consent
B: Inclusion Criteria:

* Persons \> 21 years of age
* first time recipient of a solitary kidney transplant
* prescribed at least 3 medications for immunosuppression and hypertension
* previous history of non-adherence
* functioning kidney transplant
* ability to speak, hear and understand English
* able to use medication delivery device and self administer medications
* able to operate blood pressure monitor
* comfortable using cell phone
* no other diagnosis that might shorten lifespan
* transplant physician's assent that the patient can participate

Exclusion Criteria:

* failure to meet all inclusion criteria
C: Inclusion Criteria:

* Patient is an adult (18 years of age or older).
* Patient is a recipient of a deceased or living donor kidney transplant.
* Patient is able to comply with study procedures for the entire length of the study.
* Patient has been informed about the study survey and has signed an informed consent form.

Exclusion Criteria:

* Patient is unable or unwilling to complete study patient reported outcome questionnaires.
* Patient is currently receiving azathioprine
* Patient is currently receiving an mTOR inhibitor (sirolimus, everolimus)
* Patient is currently receiving an belatacept
* Patient has received investigational immunosuppression 1 month prior to transplant or post-transplant
* Patient is in a setting where a professional care taker is responsible for dispensing subject's medication.
D: Inclusion Criteria:

* Subjects age 11 - 24 years
* At least 3 months post kidney transplant

Exclusion Criteria:

* Significant neurocognitive disabilities limiting the subject's ability to understand and participate on their own
* Unable to communicate in English or French (Montreal site)
* Unable to communicate in English (all other sites)

Answer: B