Transition Challenge in Pediatric Clinical Practice: Rough Road from Childhood to Adulthood

The transition from pediatric to adult health care is a challenging process of importance for the future well-being of patients with different chronic diseases. Unfortunately, many studies have demonstrated unsuccessful transitional care of pediatric patients with inborn errors of immunity (IEI). In practice, young adults often fail to attend their regular appointments with an adult immunologist and stop taking medication (antibiotic prophylaxis, immunoglobulin replacement, chronic immunosuppressants, or biologic therapy). In order to avoid the occurrence of permanent consequences, poorer disease outcome, and higher rate of morbidity and mortality, it is important to identify core components and potential indicators of successful transition. Transition is a long-lasting process that occurs during vulnerable periods when young people are trying to achieve full independence from their parents in decision-making. Therefore, to enable maximum functioning of IEI patients in adulthood, it is necessary to start education early and gradually through well-structured and organized national transitional programs providing continuous medical, psycho-emotional, and mental health support to patients and their parents for achieving prosperous transfer from pediatric to adult health care. European consensus guidelines for the transition of young patients with IEI were presented, but still not implemented and standardized as evidence-based guidelines in clinical practice. The European League Against Rheumatism (EULAR) and the Pediatric Rheumatology European Society (PReS) gave the first recommendations for a successful transition, with multidisciplinary teams that will help young adults and their families to provide direct communication and facilitate the process of transferring to an adult health institution in accordance with their individual needs. To foster this challenging process, it is important to prepare them to be independent and responsible individuals for their own health. Transition will be more successful if we plan it several years in advance, with multidisciplinary teams, through special national transitional programs adjusted to the individualized needs of each IEI patient and their families.