Rianthavorn P, Ettenger R B
Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752, USA.
Pediatr Transplant. 2005 Jun;9(3):398-407. doi: 10.1111/j.1399-3046.2005.00358.x.
Recent advancements in immunosuppression and surgical techniques have significantly improved the outcome of kidney transplantation in the pediatric population. Adolescents enjoy the best 1-year graft survival of any age group. However, the long-term transplant outcome in adolescents is disappointing. Non-adherence with immunosuppressive medications is one of the most important contributing factors for graft rejection and loss in teenagers. The impact of non-adherence is perceived to be far more powerful in adolescent transplant recipients than in the transplant population as a whole. To better understand adolescent non-adherence, the process of transplantation must be placed in the context of adolescent development. Adolescents try to establish their identity and autonomy separately from the parents; however at the same time, adolescents with chronic illness require help, support and guidance from adults, including parents and medical personnel. Adolescents have limited ability to anticipate abstractly the long-term consequences of their immediate actions. This inconsistency can create frustration in both adolescents and in the supporting systems around them. Despite the significant consequences of adolescent non-adherence, research in this area is scarce. There are still no established definitions, standardized diagnostic methods and effective interventions to treat and prevent this problem. We propose the recommendations to approach the problems of adolescent transplant non-adherence from the transplant clinician's viewpoint. With early identification and appropriate interventions, significant improvement in adolescent graft survival is possible.
免疫抑制和手术技术的最新进展显著改善了儿科人群肾移植的结果。青少年在所有年龄组中1年移植肾存活率最高。然而，青少年的长期移植结果却令人失望。不坚持服用免疫抑制药物是青少年移植肾排斥和丢失的最重要因素之一。人们认为，不坚持服药对青少年移植受者的影响比对整个移植人群的影响要大得多。为了更好地理解青少年不坚持服药的问题，必须将移植过程置于青少年发育的背景中。青少年试图独立于父母确立自己的身份和自主性；然而与此同时，患有慢性病的青少年需要包括父母和医务人员在内的成年人的帮助、支持和指导。青少年抽象地预见其即时行为的长期后果的能力有限。这种矛盾会给青少年及其周围的支持系统都带来挫折感。尽管青少年不坚持服药会产生重大后果，但该领域的研究却很少。目前仍没有既定的定义、标准化的诊断方法以及治疗和预防这一问题的有效干预措施。我们从移植临床医生的角度提出应对青少年移植不坚持服药问题的建议。通过早期识别和适当干预，有可能显著提高青少年移植肾的存活率。
