Kidney transplant survival in pediatric and young adults

We examined death censored graft survival in 3 cohorts of young patients transplanted at a single center. Pediatric (PED) patients transplanted at the pediatric center were compared to a cohort of young adults (YAD; age 18- < 25) and a cohort of adults (ADL; age 25-35).In a multivariate Cox model for death-censored graft survival, PED survival was statistically similar to the YAD (HR 0.86, 95% CI 0.44, 1.7, p = 0.66), however the ADL cohort (HR 0.45, 95% CI 0.25, 0.82, p = 0.009) demonstrated better survival. Admitted non-adherence rates were not different among cohorts. Patients were transferred within a narrow age window (18.6 ± 1.0 age in years) but at a wide range of times from the date of transplantation (5.1 ± 3.5 years) and with a wide range of graft function (serum creatinine 182 ± 81 μmol/L).The perception that pediatric transfers do poorly reflects advanced graft dysfunction in some at the time of transfer. The evidence also suggests that it is not the transfer of care that is the critical issue but rather recipients, somewhere between the ages of 11-14 and 25, are a unique and vulnerable cohort. Effective strategies to improve outcomes across this age group need to be identified and applied consistently.The transfer from pediatric to adult care is a challenging area of medicine for adolescents with chronic diseases and especially after kidney transplantation [1]. A high rate of graft loss associated with suspected non-adherence after transfer has been described in a small single center report [2]. It has also been our perception that pediatric patients transferring to our adult center have had a greater rate of graft loss. We also had the impression that non-adherence to medication was a key factor for inferior outcomes and wondered whether differences in patient care after transfer might trigger non-adherence. An alternative explanation for this observation might be that some patients have failing grafts at transfer. However there are several more recent