*Purpose: Kidney transplant recipients of all ages may have difficulty adhering to a strict treatment plan, adolescents and young adults are at particularly high risk for poor adherence. In previous reports, young people also have the highest risk for graft failure of any age group. In recent years, attention has been focused on how to enhance medical care for the adolescent and young adult (AYA) generation, and measures for medical care and care for the AYA generation in patients with pediatric cancer, congenital diseases, and chronic pediatric diseases are important issues. Kidney transplantation (KT) is a beneficial treatment not only for the body but also for life stages for pediatric patients with renal failure, and it is thought that the way the AYA generation spends will greatly affect their lives thereafter. The aim of this study was to investigate patient background, employment and re-transplantation in the AYA generation of graft loss after pediatric KT.

*Methods: We performed a retrospective cohort study on pediatric kidney transplant recipients, aged 15 years or younger, who received their first transplant between 1975 and 2009. Recipients were graft loss in AYA generation (15-40 years old) and followed from KT until the last known date alive as of May 2017.

*Results: Among the 323 children who underwent first KT during the study period, 80 children (24.8%) were graft loss in AYA generation after KT. Forty-eight patients who continued to visit the hospital were included in this study. The median duration of follow-up was 25.0 years (IQR 20.3-31.0). The median age at first KT was 11.2 years (IQR 6.4-12.9) and median age at the time of graft loss was 21.7 years (IQR 19.1-26.0). The most common cause of graft loss was chronic allograft nephropathy (93.7%). The overall graft half-life was 11.8 years. Nonadherence to immunosuppressive medication was 16.7%, and the age of onset was 15 to 20 years old in 75%. However, there was no significant difference in graft survival by nonadherence (p=0.74). Overall, 29 patients (60.4%) were employed, 7 patients (14.6%) were married, and 3 patients had a baby. Of the 48 patients, 25 (52%) underwent second KT at median age of 25.8 years (IQR 22.3-28.5). Twenty-three patients (92%) had living kidney transplants, six patients (24%) had ABO-incompatible KT, and 13 patients (52%) had preemptive KT. The employment rate did not decrease, and five patients were married after re-transplantation.

*Conclusions: Many patients who had graft loss in the AYA generation are forced to choose renal replacement therapy at a stage in their development of social independence. In our study, patients who were re-transplanted in the AYA generation were able to progress to social independence. Addressing the medical health care of the AYA generation of patients with end-stage renal failure is an important challenge for building a fuller life stage and a more productive society.

« Back to 2021 American Transplant Congress