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Young adult and adolescent kidney transplant recipients have shorter graft survival than older and younger recipients. Although multifactorial, the tendency toward premature graft loss in young kidney transplant recipients has often been attributed to medication nonadherence and the transition from pediatric to adult care. Multiple interventions for medication nonadherence in kidney transplant recipients have been studied. Potential preventative interventions include pre-transplant screening, transition and young adult clinics, technologies such as reminders or mobile applications, and simplification of the post-transplant medication regimen. There are also recent advances in monitoring interventions for nonadherence in transplant recipients, including electronic monitoring devices such as wireless pill bottles and the Ingestible Sensor System, which incorporates ingestible microsensors into medications. Treatment interventions for medication nonadherence include cognitive behavioral programs, behavioral contracts, and screening and treatment for depression. Several of the interventions reviewed are currently available to providers caring for young kidney transplant recipients, without any complex programmatic changes. Further research in all of these areas would be of great value.

BACKGROUND The number of Public Health Service increased-risk organ donors (PHS IRD) is growing, largely from an increase in intravenous drug use overdoses due to the current opioid epidemic. MATERIAL AND METHODS We conducted a retrospective case series review using our single-center data. We reviewed 82 PHS IRD kidney transplant offers between 2015 and 2017, 20 of which were declined. We reviewed outcomes of patients who declined vs. accepted PHS IRD offers. We studied the effect of education on these patients' willingness to consider another PHS IRD. RESULTS Twenty patients declined PHS IRD over a 2-year period. They waited on average 9 months for another transplant, and tended to be transplanted with a higher-KDPI kidney than the one originally offered. Patients who declined PHS IRD were more likely to be predialysis, women, and Asian American, and to require an interpreter. Ninety-two percent of patients who received education on PHS IRD after declining an offer stated that they would consider another PHS IRD offer in the future. Four of these patients received a PHS IRD transplant. CONCLUSIONS Our results suggest that education of patients may have a positive impact on patient attitudes toward PHS IRD.