Problematic issues of optimizing the transfer of renal transplant recipients from pediatric to adult health care (literature review)

Abstract

The transfer of kidney transplant recipients from pediatric to adult healthcare should be a planned process, as it involves various risks, including loss of the transplanted organ and death of the patient. The most critical age for the development of adverse events is the age of 17–24 years. This is because of the peculiarities of the maturation of the brain of adolescents, severe kidney disease and the need for constant medication. At this age, patients experience peer pressure, preoccupation with their appearance, personal development, pursuits and dreams for the future, which may not come true against the background of a long-term chronic illness and lead to low self-esteem, depression and anger. The result of these psycho-emotional experiences may be non-compliance with the regimen of immunosuppressive drugs with the development of rejection, and even loss of a kidney transplant. The transition process should ideally take several years and start early, usually between the ages of 12 and 14. The transfer should be carried out not only after the onset of a certain age, but also based on the existing skills and readiness of the patient. The patient must remain in the pediatric service if severe complications (rejection, infections) develop until they are treated and for at least 1 year after transplantation, even if this period is the age of transition to adult service. Following a transition readiness assessment, a structured plan should be drawn up requiring the integration of medical, educational, behavioral and social strategies both during and after the transition. Establishing transitional clinics or assigning a position of coordinator allows controlling the transition process and minimize possible risks and negative consequences. The development and implementation of programs for the transition of kidney transplant recipients to adult service are aimed at increasing the survival of the kidney transplant and patients, improving their quality of life.