Transition from pediatric to adult care in thoracic transplantation-Challenges and opportunities.

Background: Advances in medical care and improved transplant outcomes have led to a increasing number of adolescent and young adult solid organ transplant recipients entering adult-orientated services. Adolescence is a period associated with rapid physical, cognitive and psychosocial change. For thoracic transplant recipients it is a period associated with higher rates of acute and chronic rejecyion and mortality. These factors make transition and transfer particularly high-risk periods. Methods: This paper explores the challenges encountered in the transition and transfer of heart and lung transplant recipients from pediatric to adult care. Examining the structural, psychosocial, developmental and systemic barriers that influence outcomes and appraises best-practice statements and emerging models of care to identify actionable opportunities. Results: Key barriers include fragmented service structure, gaps in continuity, developmental vulnerabilities (executive functioning, autonomy, risk-taking) and system-level constraints (policies, funding, access). Evidence and consensus highligh the importance of a planned, graduated, patient-centered transition process. Opportunities to improve outcomes included dedicated transition programs, intentional pediatric-adult interdisciplinary collaboration, provision of targeted health information and structured self-management skills training for adolescents and young adults and their carers. Conclusions: Successful transition and management of adolescents and young adults with a heart and/or lung transplant requires coordinated efforts among pediatric and adult providers, patients, their caregivers and health care systems. Implementing structured, youth-appropriate, patient-centred transition pathways, grounded in collaboration, continuity of care and skills building, offers a clear route to improving long-term outcomes for this vulnerable population.