Transplanting a Kidney Is the Easy Part

The transition fromadolescence to adulthood is difficult under the best of circumstances. Youngpeoplewith chronic diseases face particular challenges because theymust adhere to medical therapy and keep medical appointments while they cope with peer pressure, hormonal surges, academic demands, anduncertainty regarding the future. This studydemonstrates the profound challenges of adolescents with renal transplants. The 10year risk of graft loss among recipients aged 14 to 16 years is the highest of any age cohort despite the robustprotoplasmof this agegroup.Weagreewith the authors that transition programs that address the unique developmentalneedsofyouthshouldbedevelopedandtested. Thestudyhasanother important lesson in thiseraofhealth care reform. Graft loss was significantly greater among publicly insured recipients compared with those with private insurance. Themagnitudeof thedifferencewas sogreat that the graft survival of privately insured patients receiving a deceased donor kidney was as good as that of publicly insured patients receivingakidneyfromalivingdonor. Inasimilarvein, African Americans had significantly higher rates of graft failure. Clearly, having health insurance is a necessary but insufficient condition to guarantee thebest health outcomes. Even when we succeed in providing sophisticated, heroic technologic interventions suchaskidney transplants, the lackofother basic social supports such as help getting to appointments, counseling for improving medical adherence, or even housing impedes patients frombenefiting fromadvancedmedical treatments.Asweaddress the lackofhealth insurance,wemust also address other inequalities in our society that prevent people from achieving the highest state of health.