Medication adherence in pediatric kidney transplantation: How to build a bridge over troubled water

Area of Science:

• Pediatric Nephrology
• Transplantation Immunology
• Adherence Research

Background:

• Medication adherence is critical for long-term graft survival in pediatric kidney transplant recipients.
• Nonadherence presents a significant and persistent challenge in this population.
• Previous research, including foundational work by Dr. Fine over 45 years ago, has sought to understand and address nonadherence.

Purpose of the Study:

• To provide a comprehensive review of adherence-enhancing interventions for pediatric kidney transplantation.
• To focus on strategies that are effective, clinically embeddable, and sustainable.
• To discuss pre-transplant interventions and retransplantation decisions for patients with nonadherence-induced graft loss.

Main Methods:

• Comprehensive literature review of adherence-enhancing interventions.
• Analysis of strategies for identifying patients needing support.
• Discussion of timing and decision-making for interventions and retransplantation.

Main Results:

• Identified various adherence-enhancing interventions applicable to pediatric kidney transplant recipients.
• Highlighted the importance of early and ongoing support.
• Provided guidance on managing nonadherence-induced graft loss and retransplantation.

Conclusions:

• Effective and sustainable interventions are crucial to overcome nonadherence in pediatric kidney transplantation.
• A multi-faceted approach, including pre-transplant interventions and careful retransplantation considerations, is necessary.
• Improving adherence can significantly impact graft survival and patient outcomes.