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Five\u2010 and 10\u2010yr patient survival rates have dramatically improved over the last couple of decades, and currently, over 80% of pediatric patients survive into adolescence and young adulthood. Waiting list mortality has been a concern for liver, heart, and intestinal transplantation, illustrating the importance of transplant as a life\u2010saving therapy. Unfortunately, the success of pediatric transplantation comes at the cost of long\u2010term or late complications that arise as a result of allograft rejection or injury, immunosuppression\u2010related morbidity, or both. As transplant recipients enter adolescence treatment, non\u2010adherence becomes a significant issue, and the medical and psychosocial impacts transition to adulthood not only with regard to healthcare but also in terms of functional outcomes, economic potential, and overall QoL. This review addresses the clinical and psychosocial challenges encountered by pediatric transplant recipients in the current era. 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