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Nonadherence after pediatric renal transplantation

detection and treatment

Holmberg, Christer

Current Opinion in Pediatrics: April 2019 - Volume 31 - Issue 2 - p 219–225
doi: 10.1097/MOP.0000000000000734
NEPHROLOGY: Edited by Michel Baum
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Purpose of review Nonadherence is a problem in adolescents and young adults. Risk factors are classified as those of the individual, family, health-care-system, or community. I present the latest reports and how to tackle nonadherence.

Recent findings Nonadherence risk is independent of one's origin in a high-poverty or low-poverty neighborhood or having private or public insurance in respect to African Americans. Females with male grafts have higher graft-failure risks than do males. Female recipients aged 15–24 with grafts from female donors have higher graft-failure risk than do males. In study of nonadherence risks, such findings must be taken into account. Antibody-mediated rejection is seen in nonadherence. The sirolimus and tacrolimus coefficient of variation is associated with nonadherence, donor-specific antibodies, and rejection. Adolescents had electronically monitored compliance reported by e-mail, text message or visual dose reminders and meetings with coaches. These patients had significantly greater odds of taking medication than did controls. Transition programs have an impact on renal function and rejection episodes.

Summary Individual risk factors are many, and methods for measuring nonadherence exist. Each transplant center should have a follow-up program to measure nonadherence, especially in adolescence, and a transition program to adult care.

Hospital for Children and Adolescents, University of Helsinki, and Helsinki University Central Hospital, Helsinki, Finland

Correspondence to Christer Holmberg, PhD, MD, Hospital for Children and Adolescents, University of Helsinki, Stenbäckinkatu 11, 00290 Helsinki, Finland. Tel: +358 504271696; e-mail: christer.holmberg@hus.fi

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