Self-management and liver allograft rejection in adolescence and beyond

We read with interest the study by Annunziato et al on self-management and allograft rejection in pediatric liver transplant recipients.1 A vexing challenge in pediatric organ transplantation is the "high-risk window" of graft failure and mortality as transplant recipients age into young adulthood.2-4 Changing patterns of treatment adherence and self-management during this time offer an intuitive explanation for the increase in risk.3 Provocatively, the present study demonstrates that greater self-management predicted an increased risk of liver allograft rejection in children and adolescents 9-17 years of age.

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