Children’s Health: Growing up is risky for childhood transplant patients

New kidneys can stop working unexpectedly after kids switch to adult care

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A Canadian study has shown that children who receive kidney transplants may run into problems when they grow up and make the transition from pediatric to adult care.

Doctors at the Sainte-Justine University Health Centre, a pediatric hospital in Montreal, tracked 31 girls and 38 boys who received a kidney transplant at an average age of 12 years and were later sent to an adult hospital for their care. Over the course of the study, 26 patients (38 per cent) lost their new kidney after the transfer to adult care.

In some cases, the kidney was working fine before the transfer to adult care, but stopped functioning unexpectedly because the patient didn’t stick with the medication needed to prevent rejection of the organ.

“We invest so much in these kids and we work hard with them and their families. It is so sad to see them lose their kidney because they are not attentive to their own care. We have a duty to make sure they are OK,” says Dr. Marie-José Clermont, a professor of pediatrics who helps run the pediatric kidney transplant program at the hospital. “Adult care is quite different. You are on your own. You will get help if you ask for it but they don’t go overboard for you as a patient. Some of these kids may not be grown up enough to go to the adult care.”

For example, adult hospitals may not do as thorough a job as pediatric hospitals of following up with patients who miss appointments or blood tests, so there is more responsibility placed on the patients’ shoulders for those aspects of care.

Clermont says the transition from pediatric to adult care is an issue for more than just kidney transplants. “This is a problem with other types of transplant patients, cystic fibrosis patients and patients with other chronic diseases.”