Heightened graft failure risk during emerging adulthood and transition to adult care

Emerging adulthood, defined as the interval between 18 and 25 years of age, is a socially-defined developmental stage. Although people in this age group appear physically mature, brain maturation is not complete until the end of this period. Perhaps due to this immaturity and a resulting inferior ability to manage chronic illness emerging adults with a variety of chronic health conditions are at a high risk for adverse outcomes. In this review I will summarize evidence that emerging adulthood constitutes a high-risk period for kidney transplant recipients, and consider the possible reasons for the spike in graft failure risk during this age interval-including age-related adherence behaviour and the changes in care organization, processes and structures associated with transfer from pediatric to adult-oriented care. I will also discuss evidence showing transfer from pediatric to adult-oriented care contributes to this elevated risk, and highlight the limitations and challenges of studies examining this question. Finally, I will direct readers to resources providing guidance on the best practices for care of patients transitioning to adult care.