Progressive Allograft Injury, Chronic Rejection, and Nonadherence

  • Dana Mannino
Reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)


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.


Adherence Nonadherence Immunosuppression Pediatric transplantation Rejection Adolescence Antibody-mediated rejection Chronic rejection Graft survival Kidney transplant Liver transplant Heart transplant Barriers Transition 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Solid Organ Transplantation, A.I. duPont Hospital for ChildrenWilmingtonUSA

Section editors and affiliations

  • Deborah M Consolini
    • 1
  1. 1.Nemours/Alfred I. duPont Hospital for ChildrenWilmingtonUSA

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