Abstract

Non-Adherence (NA) to medical regimen after transplantation remains as the leading cause of graft loss. The adolescents and young adults are at higher risk for NA than adults. It has been stressed the multi-factorial nature of NA, however biological mechanisms of NA have not been investigated. Adverse Childhood Experiences (ACE) are related to short and long-term negative physical and mental health consequences among children and adults, more over depression in adolescents and adults observed in chronic kidney disease and after transplantation are characterized by cell-mediated immune activation and inflammation. This article examines the current literature regarding each of these factors, proposes a biological hypothesis for NA and gives suggestions for the prevention of ACE, depression and therefore of the N

Keywords:Adherence; Transplantation; Depression; Adverse Childhood Experiences(ACE)

Abbreviations: ACE: Adverse Childhood Experiences; CKD: Chronic Kidney Disease; HPA: Hypothalamic- Pituitary-Adrenal; IDO: Indoleamine-2,3-Dioxygenase; IL: Interleukin; INF: Interferon; NA: Non-Adherence; Stnf: Soluble Tumor Necrosis Factor; sTNFR: Soluble Tumor Necrosis Factor Receptor; TCMR: T cell Mediated Rejection; TNF: Tumor Necrosis Factor.