title: Adherence to medical recommendations and transition to adult services in pediatric transplant recipients.
abstract: OBJECTIVE
  Nonadherence to treatment recommendations, especially when associated with transition to adult care providers, account, by some estimates, for most organ rejections and death in long-term pediatric survivors of solid organ transplantations. It is therefore imperative that providers become familiar with the issues related to those major risks and ways to address them.
  
  
  RESULTS
  It is possible, and important, to routinely measure adherence to medications by using one of several available and proven methods of surveillance. There are numerous ways to improve adherence, and it is in fact possible to improve adherence and therefore outcomes in the transplant setting. The transition to adult services is a vulnerable period. The authors believe that it is possible to improve the transition process, and suggestions are presented in this review. However, solid research into interventions to improve transition is lacking.
  
  
  CONCLUSIONS
  Nonadherence to medical recommendations is prevalent and leads to poor outcomes following otherwise successful pediatric transplantation. An especially vulnerable period is the time when a recipient transitions to adult care. Routine monitoring of adherence, evaluating and addressing barriers to adherence, and collaborative, multidisciplinary care are all expected to substantially improve adherence and reduce the risks associated with transition.
authors.affiliation: Division of Developmental and Behavioral Health, Department of Pediatrics and The Kravis Children's Hospital, New York 10029, USA. eyal.shemesh@mssm.edu
authors.forename: Eyal
authors.initials: E
authors.lastname: Shemesh
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Annunziato
authors.forename: Ronen
authors.initials: R
authors.lastname: Arnon
authors.forename: Tamir
authors.initials: T
authors.lastname: Miloh
authors.forename: Nanda
authors.initials: N
authors.lastname: Kerkar
mesh_terms: D000293:Adolescent; D000328:Adult; D003266:Continuity of Patient Care; D016903:Drug Monitoring; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control*; D006085:Graft Survival; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D055118:Medication Adherence; D016377:Organ Transplantation / Q000009:adverse effects; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
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