Adherence in pediatric kidney transplant recipients: solutions for the system

Abstract

Non-adherence remains a significant problem among pediatric (and adult) renal transplant recipients. Non-adherence among solid organ transplant recipients results in US$15-100 million annual costs. Estimates of non-adherence range from 30 to 70% among pediatric patients. Research demonstrates that a 10% decrement in adherence is associated with 8% higher hazard of graft failure and mortality. Focus has begun to shift from patient factors that impact adherence to the contributing healthcare and systems factors. The purpose of this review is to describe problems within the systems implicated in non-adherence and potential solutions that may be related to positive adherence outcomes. Systems issues include insurance and legal regulations, provider and care team barriers to optimal care, and difficulties with transitioning to adult care. Potential solutions include recognition of how systems can work together to improve patient outcomes through improvements in insurance programs, a multi-disciplinary care team approach, evidence-based medical management, pharmacy-based applications and interventions to simplify medication regimens, improved transition protocols, and telehealth/technology-based multi-component interventions. However, there remains a significant lack of reliability in the application of these potential solutions to systems issues that impact patient adherence. Future efforts should accordingly focus on these efforts, likely by leveraging quality improvement and related principles, and on the investigation of the efficacy of these interventions to improve adherence and graft outcomes.

Psychosocial predictors of medication non‐adherence in pediatric organ transplantation: A systematic review

“…This review synthesized the current literature to identify psychosocial predictors of medication non‐adherence among pediatric transplant recipients and their families. Medication non‐adherence in pediatric organ transplantation is a multifaceted health behavior which can be challenging for families caring for a child with a transplanted organ and for healthcare professionals working to promote adherence . Results from the review emphasize the importance of considering psychosocial issues with the child, adolescent, parent or caregiver, and the larger family environment when assessing for post‐transplant medication adherence.…”

“…Medication non-adherence in pediatric organ transplantation is a multifaceted health behavior which can be challenging for families caring for a child with a transplanted organ and for healthcare professionals working to promote adherence. 94 Results from the review emphasize the importance of considering psychosocial issues with the child, adolescent, parent or caregiver, and the larger family environment when assessing for post-transplant medication adherence. The varying results of the current literature along with the content and methodological gaps that remain in this body of knowledge make it essential for additional research in this area to occur.…”

Social deprivation is associated with poor kidney transplantation outcome in children

“…11,22,23 It is also known that socioeconomic conditions, family support, and functioning are major contributors to nonadherence. [24][25][26] Our study has some strengths and limitations. The Renal Epidemiology and Information Network registry is a comprehensive and validated nationwide renal registry that includes all pediatric and adult kidney transplant recipients in France.…”

<p>Effect and features of information technology-based interventions on self-management in adolescent and young adult kidney transplant recipients: a systematic review</p>

“…Also, adolescents and young adults are typically less adherent to immunosuppressive medication than elderly transplant recipients,8,9 thus increasing the risk of graft rejection or loss 2,8. Based on previous research, the highest allograft rejection rate has been observed in 16- to 21-year-old patients 2,10. Also, the worst clinical outcomes of kidney transplantation are observed in adolescent and young adult transplant recipients as compared to other age groups 11.…”