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Is tolerance induction the answer to adolescent non-adherence?

Kiran K Dhanireddy1, Jennifer Maniscalco, Allan D Kirk

  • 1Transplantation Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD 20892, USA.

Pediatric Transplantation
|May 25, 2005
PubMed
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Achieving transplantation tolerance in adolescents is challenging due to developmental and immunological factors. Strategies like removing harsh medications may improve adherence and tolerance outcomes for young transplant recipients.

Area of Science:

  • * Transplantation immunology
  • * Adolescent medicine
  • * Clinical trial design

Background:

  • * Adolescent medication non-adherence is a significant clinical problem.
  • * Transplantation tolerance aims to eliminate lifelong immunosuppression.
  • * Adolescents present unique challenges for tolerance induction.

Purpose of the Study:

  • * To review the concept of transplantation tolerance.
  • * To examine the barriers to implementing tolerance strategies in adolescents.
  • * To discuss the potential of pro-tolerant therapies in adolescent recipients.

Main Methods:

  • * Review of current literature on transplantation tolerance.
  • * Analysis of immunologic, psychosocial, and ethical considerations in adolescent transplantation.

Related Experiment Videos

  • * Discussion of alternative strategies, including medication adjustment.

    • Main Results:

    • * Adolescent immunologic maturity is adult-like, but cognitive and emotional maturity are limited.
    • * Immunologic, psychosocial, and ethical barriers currently temper enthusiasm for adolescent tolerance trials.
    • * Removing medications with harsh side effects (e.g., steroids, calcineurin inhibitors) may be an interim step.

    Conclusions:

    • * Current tolerance strategies face significant hurdles in adolescent populations.
    • * Modifications to immunosuppressive regimens may improve adherence and pave the way for tolerance.
    • * Further research is needed to safely and effectively apply tolerance strategies in adolescents.