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Progressive Allograft Injury, Chronic Rejection, and Nonadherence

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Solid Organ Transplantation in Infants and Children

Part of the book series: Organ and Tissue Transplantation ((OTT))

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Abstract

Nonadherence is a major health concern in pediatric transplantation. This chapter describes nonadherence and its impact in pediatric organ transplantation. Nonadherence is prevalent among kidney, heart, and liver transplant recipients, especially in adolescents and early young adults. Organ rejection is reviewed as a complication of transplant including acute cellular rejection, acute antibody-mediated rejection, and chronic rejection/antibody-mediated rejection. Associations are discussed between nonadherence and rejection as well as graft loss/failure and patient survival across the three organ systems. Chronic immunosuppressive medications are reviewed, as medication nonadherence is highly associated with graft loss. Types of nonadherence are reviewed as well as barriers to adherence and risk factors for nonadherence. Assessing for nonadherence and measuring adherence are imperative in devising individualized strategies for promoting adherence, preventing nonadherence, and intervening when nonadherence exists. Transitioning to adult care is discussed, as this is a critical time period that is vulnerable to nonadherence and its negative consequences.

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Author information

Authors and Affiliations

  1. Division of Solid Organ Transplantation, A.I. duPont Hospital for Children, Wilmington, DE, USA

    Dana Mannino

Authors
  1. Dana Mannino
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Correspondence to Dana Mannino .

Editor information

Editors and Affiliations

  1. Department of Surgery, Jefferson Medical College, Wilmington, Delaware, USA

    Stephen P. Dunn

  2. Division of Gastroenterology, Seattle Children’s Hospital, Seattle, Washington, USA

    Simon Horslen

Section Editor information

  1. Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA

    Deborah M Consolini

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Mannino, D. (2018). Progressive Allograft Injury, Chronic Rejection, and Nonadherence. In: Dunn, S., Horslen, S. (eds) Solid Organ Transplantation in Infants and Children. Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-07284-5_52

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  • DOI: https://doi.org/10.1007/978-3-319-07284-5_52

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-07283-8

  • Online ISBN: 978-3-319-07284-5

  • eBook Packages: MedicineReference Module Medicine

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