Mitigating Risk Associated With the Transition From Pediatric to Adult Kidney Transplant Care: Strategies to Promote Success.

Young adult kidney transplant recipients experience poorer outcomes. Specifically worse allograft survival has been reported in the United States and worldwide. Pediatric to adult transition-related research has focused predominantly on medication nonadherence. However, the cause of worse graft outcomes in young adults is likely due to a multitude of complex factors. Consensus guidelines were issued to guide pediatric and adult transplant teams during the transition process. To what extent these transition guidelines are utilized and their impact on improving outcomes for young adult patients is unclear. The consensus guidelines serve as a useful resource, but investigation of the potential barriers to putting these transition guidelines into practice is lacking. One must consider the unique needs of medically complex patients, financial disincentives to transition programs, paucity of evidence-based data to support individual aspects of a transition program and their impact on transition success, and absence of strategies to address health care disparities, all of which can have a multiplicative risk for this population. Key transition research is needed to yield evidence-based data to support transition practices that are successful and truly improve outcomes in this high-risk transplant population. It will also allow better stewardship of transplant organs by optimizing outcomes and allograft longevity.