Pediatric Nephrology

, Volume 33, Issue 3, pp 361–372 | Cite as

Adherence in pediatric kidney transplant recipients: solutions for the system

  • Elizabeth A. Steinberg
  • Mary Moss
  • Cindy L. Buchanan
  • Jens Goebel
Review
First Online:
Received:
Revised:
Accepted:

Abstract

Non-adherence remains a significant problem among pediatric (and adult) renal transplant recipients. Non-adherence among solid organ transplant recipients results in US$15–100 million annual costs. Estimates of non-adherence range from 30 to 70% among pediatric patients. Research demonstrates that a 10% decrement in adherence is associated with 8% higher hazard of graft failure and mortality. Focus has begun to shift from patient factors that impact adherence to the contributing healthcare and systems factors. The purpose of this review is to describe problems within the systems implicated in non-adherence and potential solutions that may be related to positive adherence outcomes. Systems issues include insurance and legal regulations, provider and care team barriers to optimal care, and difficulties with transitioning to adult care. Potential solutions include recognition of how systems can work together to improve patient outcomes through improvements in insurance programs, a multi-disciplinary care team approach, evidence-based medical management, pharmacy-based applications and interventions to simplify medication regimens, improved transition protocols, and telehealth/technology-based multi-component interventions. However, there remains a significant lack of reliability in the application of these potential solutions to systems issues that impact patient adherence. Future efforts should accordingly focus on these efforts, likely by leveraging quality improvement and related principles, and on the investigation of the efficacy of these interventions to improve adherence and graft outcomes.

Keywords

Adherence Kidney transplant Healthcare system Pediatric Quality improvement Immunosuppression 
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Notes

Authors’ contributions

All authors listed have made substantial, direct, and intellectual contributions to the work, and approved it for publication.

Compliance with ethical standards

Conflict of interest

All authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Copyright information

© IPNA 2017

Authors and Affiliations

  • Elizabeth A. Steinberg
    • 1
  • Mary Moss
    • 2
  • Cindy L. Buchanan
    • 1
    • 3
  • Jens Goebel
    • 4
  1. 1.Department of PsychiatryUniversity of Colorado School of MedicineAuroraUSA
  2. 2.Department of PharmacyChildren’s Hospital ColoradoAuroraUSA
  3. 3.Department of SurgeryUniversity of Colorado School of MedicineAuroraUSA
  4. 4.Department of PediatricsUniversity of Colorado School of MedicineAuroraUSA

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