OBJECTIVES: To address limited data in Midwest solid organ transplant recipient (SOTR) populations we determined the patient’s demographic and medical characteristics associated with self-reported immunosuppressant (IST) adherence on a 4-item measure (ITAS).  METHODS: Cross-sectional survey-data (patient: residence zip code, education, marital status, annual income, health-status, insurance coverage; condition: comorbidities; therapy: total number of medications other than IST; and ITAS) was received from >/=19 year old adult SOTR of an academic transplant center located in mid west US.  For this retrospective study, survey-data were merged with other patient (age, race, gender); condition (transplant-type, years since last transplant); IST-drug therapy-data from the center’s database.  Multivariate stepwise logistic regression was used to identify significant patient characteristics for the dependent variable of being “adherent” (ITAS score =12) compared with being “nonadherent” (ITAS score <12).  RESULTS: Respondents had either kidney (269 [48.5%]), liver (263[47.2%]), or other (25[4.5%]) transplant. Other respondent characteristics were: age (mean 56 years), male (55.5%), white (90.1%), married (69.9%), less than $55,000 annual income (57.3%), metro-resident (59%), Medicare-insurance (47.8%), excellent to good health status (77.5%), years since last transplant (mean 7.53 +/- SD 5.87).  The SOTRs were on different IST regimens (Tacrolimus based combination IST drugs, 39.2%, Tacrolimus, 22.3%, Cyclosporine, 20.7%, Cyclosporine combinations, 9%, Other, 8.8%).  More than half (320/557; 57.5%) of the SOTRs self-reported “adherence”. In a multivariate stepwise logistic regression model including all patient characteristics; age less than 65 years (p=0.0002), living in non metro rural areas (p=0.041), and greater than or equal to  6 co-morbidities (p=0.0040) significantly decreased the likelihood of adherence compared with nonadherence.  In the same model, however, Tacrolimus based combination-IST rather than Tacrolimus alone (p = 0.019), significantly increased the likelihood of adherence compared with non-adherence. CONCLUSIONS: Our study identified patient, condition, and IST-therapy correlates of IST-adherence which providers may consider to deliver IST-adherence improving interventions.