Renal allograft loss during transition to adult healthcare services among pediatric renal transplant patients.
BACKGROUND
Transition to adult care occurs at age 18 during a vulnerable adolescent period for pediatric renal transplant (RTx) patients.


METHODS
We examined renal allograft loss and hospitalization for RTx biopsy or rejection before and after transition to adult care using clinical and administrative health records of children who underwent RTx (1992-2002) in Ontario, Canada. Life-table analyses examined event rates/100 person years according to age at first RTx.


RESULTS
A total of 115 patients were included (57% men; mean age at first transplant 13.9+/-3.7 years). Allograft loss rates were similar across ages 14.0 to 23.9 years. No increase in allograft loss was observed during transition period (ages 18.0-19.9 years). Hospitalizations for RTx rejection or biopsy were much lower after age 18.


CONCLUSIONS
Our findings do not support an increased risk of allograft loss after transition to adult care, although there is less hospital use for rejection or biopsy suggesting that differences exist in use of care before complete allograft loss after transition to adult care.
Koshy
Susan M
SM
Division of Nephrology, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada. susan.koshy@albertahealthservices.ca
Hebert
Diane
D
Lam
Kelvin
K
Stukel
Therese A
TA
Guttmann
Astrid
A
D000293:Adolescent; D000328:Adult; D000375:Aging / Q000276:immunology*; D002648:Child; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D003695:Delivery of Health Care / Q000458:organization & administration*; D006084:Graft Rejection / Q000276:immunology / Q000473:pathology; D006085:Graft Survival / Q000276:immunology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology* / Q000473:pathology / Q000706:statistics & numerical data*; D009864:Ontario / Q000453:epidemiology; D010372:Pediatrics; D011785:Quality Assurance, Health Care / Q000592:standards / Q000706:statistics & numerical data*; D012307:Risk Factors; D017211:Treatment Failure