Drug Usage and Risk for Polypharmacy After Pediatric Solid Organ Transplantation: A National Register Study

Abstract

Background: Solid organ transplant (SOT) recipients are at risk for long-term comorbidities and polypharmacy, potentially affecting quality of life. This study assessed the prevalence of chronic medication use among young adults following pediatric SOT. Methods: We included 215 individuals in Finland who underwent kidney (n = 135), liver (n = 41), or heart (n = 39) transplantation before age 16 between 1982 and 2015 and were ≥18 years at follow-up. Age, sex, and hometown-matched controls (n = 1067) were selected from the Finnish Population Information System. The analyses involved data on prescription drug purchases and reimbursements for chronic conditions derived from the registry of Social Insurance Institution, which covers all prescription medicine purchases in Finland. Results: The SOT recipients had an average of 1.53 reimbursed chronic conditions beyond immunosuppression (median follow-up time:18.0 years, IQR 11.0–23.0), with the highest burden among kidney and lowest among liver transplant recipients. Compared to controls, SOT recipients had significantly more reimbursement for cardiovascular diseases, hormonal deficiencies, and epilepsy (p < 0.001). Kidney transplant recipients had a significantly higher risk of cardiovascular-related reimbursements than liver transplant group (p < 0.001); no significant differences were observed between the transplant groups for other conditions. Conclusions: Young adults after pediatric SOT had an elevated need for chronic disease medications, with the highest burden observed in kidney transplant recipients and the lowest in liver transplant recipients. These findings highlight the importance of long-term follow-up and individualized transitional care to address multimorbidity and support quality of life.