• Nathan J Jamieson, Camilla S Hanson, Michelle A Josephson, Elisa J Gordon, Jonathan C Craig, Fabian Halleck, Klemens Budde, and Allison Tong.
• Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia; Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
• Am. J. Kidney Dis. 2016 Mar 1; 67 (3): 461-78.

BackgroundKidney transplantation offers better outcomes compared to dialysis, but requires patients to adhere to an ongoing and complex self-management regimen. Medication nonadherence remains a leading cause of transplant loss, and inadequate self-management undermines transplantation and other health outcomes. We aimed to describe kidney transplant recipients' motivations, challenges, and attitudes toward self-management.Study DesignSystematic review and thematic synthesis of qualitative studies.Setting & PopulationKidney transplant recipients.Search Strategy & SourcesMEDLINE, EMBASE, PsycINFO, and CINAHL were searched to October 2014.Analytical ApproachThematic synthesis.Results50 studies involving 1,238 recipients aged 18 to 82 years across 19 countries were included. We identified 5 themes: empowerment through autonomy (achieving mastery, tracking against tangible targets, developing bodily intuition, routinizing and problem solving, and adaptive coping), prevailing fear of consequences (inescapable rejection anxiety, aversion to dialysis, minimizing future morbidity, trivialization and denial, and defining acceptable risks), burdensome treatment and responsibilities (frustrating ambiguities, inadvertent forgetfulness, intrusive side effects, reversing ingrained behaviors, and financial hardship), overmedicalizing life (dominating focus, evading patienthood, and succumbing to burnout), and social accountability and motivation (demonstrating gratitude toward medical team, indebtedness to donor, and peer learning).LimitationsNon-English articles were excluded.ConclusionsSelf-efficacy and social accountability are motivators for self-management, although adherence can be mentally and physically taxing. Multicomponent interventions incorporating personalized care planning, education, psychosocial support, decision aids, and self-monitoring tools may foster self-management capacity and improve transplantation outcomes.Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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