During the last several decades, advances in IS therapy have dramatically reduced the incidence of early acute rejection in pediatric LT recipients and contributed to increased short-term survival. 1 Despite these improvements, a substantial proportion of patients experience at least some side effects with these potent medications, many being concentration-related, which can lead to decreased adherence and subsequent allograft rejection. 2,3 Moreover, the need for lifelong IS exposes patients to considerable morbidity, including opportunistic infections, organ dysfunction, and malignancies, 4 all of which pose a serious threat to graft and patient survival. 5 Continued follow-up and routine monitoring of pediatric LT patients is therefore essential to preserve graft function, prevent complications, and enhance long-term outcomes.To this end, successful transplantation requires effective self-management, defined as "the interaction of health behaviors
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