title: Different models of transition to adult care after pediatric kidney transplantation: a comparative study.
abstract: Transition from pediatric to adult care is a critical and difficult step for young people with transplants and for the multidisciplinary team involved. In our retrospective study, we investigated the clinical course in a two-yr period of transition. Data from 66 teenagers were collected one yr before and after their transfer to three different adult care settings: (i) a specialized transition clinic, (ii) a general transplantation clinic, and (iii) a nephrologist. Patient survival rate was 100%. Three patients developed graft loss. GFR development was comparable in the three settings (ΔGFR 1.4 ± 8.7 vs. 3.1 ± 10.6 vs. 0.8 ± 4.4 mL/min/1.73 m2 , p = ns). Immunosuppressive therapy was stable in setting 1, whereas the number of changes increased in setting 2 and even more in setting 3. The percentage of patients with steroids increased from 36% to 38% and 52% in settings 1-3. Patient satisfaction was highest in setting 1 (100% vs. 64% and 78%, p < 0.05). Setting 1 was associated with fewer changes in therapy (13% vs. 91% and 45%, p < 0.05). The use of a specialized transition clinic is associated with fewer changes in medication and care and a higher level of patient satisfaction. This was not associated with a lower increase in GFR one yr after transition. Long-term results are awaited.
authors.affiliation: Department of Pediatric Nephrology, Hepatology and Metabolic Diseases, Hannover Medical School, Hannover, Germany. pape.lars@mh-hannover.de
authors.forename: L
authors.initials: L
authors.lastname: Pape
authors.forename: J
authors.initials: J
authors.lastname: Lämmermühle
authors.forename: M
authors.initials: M
authors.lastname: Oldhafer
authors.forename: C
authors.initials: C
authors.lastname: Blume
authors.forename: R
authors.initials: R
authors.lastname: Weiss
authors.forename: T
authors.initials: T
authors.lastname: Ahlenstiel
mesh_terms: D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D009173:Mycophenolic Acid / Q000627:therapeutic use; D051437:Renal Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D060305:Transition to Adult Care
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids; D016572:Cyclosporine; D009173:Mycophenolic Acid
keywords: glomerular filtration rate; pediatric kidney transplantation; transition