title: Renal allograft loss during transition to adult healthcare services among pediatric renal transplant patients.
abstract: 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.
authors.affiliation: Division of Nephrology, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada. susan.koshy@albertahealthservices.ca
authors.forename: Susan M
authors.initials: SM
authors.lastname: Koshy
authors.forename: Diane
authors.initials: D
authors.lastname: Hebert
authors.forename: Kelvin
authors.initials: K
authors.lastname: Lam
authors.forename: Therese A
authors.initials: TA
authors.lastname: Stukel
authors.forename: Astrid
authors.initials: A
authors.lastname: Guttmann
mesh_terms: 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