Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK.
Pediatr Nephrol. 2023 Feb;38(2):383-390. doi: 10.1007/s00467-022-05582-6. Epub 2022 Apr 30.
Survival of pediatric kidney transplant recipients has improved over the past six decades. However, adolescents and young adults still have the highest graft failure rates of any age group. There is a growing need for well-designed transition programs to ensure the successful integration of young adults into adult society with eventual transfer of care and management in adult transplant centers. In this review, we discuss the risk factors contributing to the high risk of kidney graft failure observed between 17 and 24 years of age, including the role of transfer from pediatric to adult care. We also address the unique challenges of adolescents with kidney transplant: the impact of chronic kidney disease on neurocognition, age-related changes in immune activity, and suboptimal adherence during the transition process. We then describe strategies to mitigate these risks by designing developmentally appropriate transition programs, and review the evidence supporting the benefits of well-designed multidisciplinary transition programs.
过去六十年来，儿科肾移植受者的存活率有所提高。然而，青少年和年轻成年人仍然是所有年龄段中移植失败率最高的群体。因此，非常需要精心设计的过渡计划，以确保年轻成年人成功融入成年社会，并最终在成人移植中心转由成人管理。在这篇综述中，我们讨论了导致 17 至 24 岁之间移植肾高失败风险的因素，包括从儿科到成人护理的转移作用。我们还探讨了肾移植青少年的独特挑战：慢性肾脏病对神经认知的影响、免疫活性随年龄的变化，以及在过渡过程中药物依从性差等问题。然后，我们通过设计适合其发展阶段的过渡计划来描述减轻这些风险的策略，并回顾了精心设计的多学科过渡计划带来的益处的相关证据。
