Yazigi Nada A
Department of Pediatrics, MedStar Georgetown Transplant Institute, 3800 Reservoir Road, NW, PHC#2, Washington, DC 20007.
Semin Pediatr Surg. 2017 Aug;26(4):267-271. doi: 10.1053/j.sempedsurg.2017.07.010. Epub 2017 Jul 25.
Adherence is proving to be the Achilles heel of pediatric transplantation. Through a careful literature review on adherence in pediatric solid-organ transplantation from 2007 to 2017, this chapter reports on the incidence, measuring tools, and consequences of poor adherence. We detail adherence determinants and interventions proposed to foster it. While adherence is a major problem in the adolescent age, it clearly is not limited to this age group. Importantly, it is not one to start tackling at that time or when it becomes apparent. Rather, fostering adherence should be built throughout the continuum of the transplant journey, starting in the pretransplantation phase. Adherence is clearly a fluid state, necessitating frequent reassessments and enforcement. Adherence in addition shares similar determinants with quality of life. The severe consequences in the case of poor adherence mandate that the transplant community prioritize it as the next frontier in transplantation. Good adherence is what will pave the road to tolerance, cost-efficient transplantation, and optimized long-term outcomes.
事实证明，依从性是小儿移植的致命弱点。通过对2007年至2017年小儿实体器官移植依从性的仔细文献综述，本章报告了依从性差的发生率、测量工具及后果。我们详细阐述了依从性的决定因素以及为促进依从性而提出的干预措施。虽然依从性在青少年时期是一个主要问题，但显然并不局限于这个年龄组。重要的是，不应等到那时或问题变得明显时才开始解决。相反，应在移植过程的整个连续阶段，从移植前阶段开始，就培养依从性。依从性显然是一种动态状态，需要经常重新评估和强化。此外，依从性与生活质量有相似的决定因素。依从性差会带来严重后果，这就要求移植界将其作为移植的下一个前沿重点。良好的依从性将为实现免疫耐受、经济高效的移植以及优化长期结果铺平道路。
