Renal transplant recipients are expected to adhere to a lifelong therapeutic regimen designed to preserve long-term graft function and to reduce the risk of complications. Adherence to immunosuppression is a critical component of this regimen, but studies using electronic monitoring, the most sensitive tool currently available, have found non-adherence rates of 20–26% in adult patients, whereas a mean prevalence of 32% has been reported among adolescent renal transplant recipients. Non-adherence after renal transplantation is an important clinical problem because even comparatively low rates of non-adherence are associated with increased risks of acute rejection, graft loss, reduced quality of life, and mortality. All members of the transplant team including hospital-based and community nephrologists, surgeons, nurses and therapists, should be aware of the possibility of non-adherence and be prepared to intervene. Promoting adherence is not straightforward, because risk factors for non-adherence are multifactorial and individual to each patient. As a result, intervention is more likely to promote lasting adherence if it is long term and takes place within the context of a chronic-illness management model that integrates behavioural, psychosocial and medical aspects of care appropriate to the unique needs of the individual patient.