Adherence and medical outcomes in pediatric liver transplant recipients who transition to adult services Nearly 6% of all children have an illness requi- ring long-term care (1). Children who are med- ically ill face an enormous task when they like other children must graduate from adolescence to adulthood. Transition to the adult healthcare system consists of two intertwined components relevant to all medically ill children (2–5). During adolescence, patients begin to experience an ongoing transition in healthcare responsibilities from their caregivers to themselves. At some specific point, actual transfer from receiving services at child-centered to adult-oriented facil- ities occurs. A position paper discussing transitioning ado- lescents (6) emphasizes the lack of a research base available to inform what strategies clinicians should use to improve current practice. Indeed, we have limited data regarding whether disease and/or functional outcomes change for trans- plant recipients during transition. Magee (7) addressed this question using the SRTR/OPTN data and found that graft loss did not accelerate during the transition period to adult services. Rather, the data demonstrated a steady deteri- oration that begins during early adolescence and continues into young adulthood. However, that study did not examine adherence per se. It could be that adherence deteriorates during transition, Annunziato RA, Emre S, Shneider BL, Barton C, Dugan CA, Shemesh E. Adherence and medical outcomes in pediatric liver transplant recipients who transition to adult services. Pediatr Transplantation 2007: 11: 608–614. Ó 2007 Blackwell Munksgaard Abstract: Non-adherence to medications is associated with poor medical outcomes in adolescent transplant recipients. It is unclear whether non-adherence is further compromised when transplant recip- ients transition to the adult health care system. The purpose of the present study was to examine whether adherence changes during transition. We reviewed the medical records of 14 recently transitioned patients and compared their adherence and corresponding medical outcomes before and after transition. These outcomes were also com- pared with two cohorts of patients receiving care solely in pediatric or adult services. Medication adherence, measured through the use of standard deviations of tacrolimus blood levels, was examined for all patients. We found that adherence to tacrolimus significantly decreased after transition. After transitioning, patients furthermore exhibited poorer adherence than patients in the other two cohorts did over time. This small retrospective study suggests that the period of transition from pediatric to adult transplant clinics is a vulnerable one. Larger, prospective investigations of the transition process are necessary before recommendations are made regarding interventions. Rachel A. Annunziato 1 , Sukru Emre 2,3 , Benjamin Shneider 2,3 , Codette Barton 3 , Christina A. Dugan 3 and Eyal Shemesh 1,2,3 Departments of 1 Psychiatry and 2 Pediatrics, Mount Sinai School of Medicine, New York, NY, USA 3 Recanati-Miller Transplant Institute, Mount Sinai Medical Center, New York, NY, USA Key words: transition – adherence – adolescents- liver transplant recipients Rachel A. Annunziato, Department of Psychiatry, The Mount Sinai School of Medicine, One Gustave L. Levy Place Box 1230, New York, NY 10029, USA Tel.: +1 212 659 8776 Fax: +1 212 849 2561 E-mail: rachel.annunziato@mssm.edu Accepted for publication 11 January 2007 Abbreviations: ALT, alanine aminotransferase; CHDs, congenital heart defects; s.d., standard deviations; SRTR/ OPTN, Scientific Registry of Transplant Recipients/Organ Procurement and Transplantation Network. Pediatr Transplantation 2007: 11: 608–614 Copyright Ó 2007 Blackwell Munksgaard Pediatric Transplantation DOI: 10.1111/j.1399-3046.2007.00689.x 608