title: Can transition to adult care for transplant recipients be improved by intensified services while patients are still in pediatrics?
abstract: Context-Transferring out of pediatrics is a vulnerable time for transplant recipients. Use of a transition coordinator before and after transfer improves outcomes, although it is unclear whether placing a transition coordinator in pediatrics alone is beneficial. Objective-To determine if incorporating a transition coordinator in pediatrics only is associated with stable outcomes for kidney transplant recipients. Design-A retrospective chart review was conducted on outcomes for kidney transplant recipients who shifted service location between 2008 and 2012. Setting-A pediatric and adult transplant unit. Patients-Twenty-two patients transferred during the study period. Intervention-Twelve patients received more intensified preparation from the team's social worker, whose role was aligned with a transition coordinator position; 10 patients received standard care. Main Outcome Measures-The primary outcome was medication adherence, using a validated measure, standard deviations of tacrolimus blood levels. A standard deviation greater than 2.5 has been established as a threshold associated with poor outcomes such as rejection. Standard deviation of tacrolimus levels was compared for 1 year before and 1 year after transfer. Results-Medication adherence worsened from 1 year before (2.03 [SD, 0.75]) to 1 year after transfer (2.95 [SD, 1.38]; t = -;3.07, P = .007). A repeated-measures analysis of variance indicated that this pattern was the same for patients who did and patients who did not receive intensified services in pediatrics (F1,16 = 1.07, P = .32).
authors: Fordham University, Bronx, New York (RAA, MP, NC), Icahn School of Medicine at Mount Sinai, New York, (RAA, KK, CB, HH, VN, JS), Westchester Medical Center and New York Medical College, Valhalla, New York (RM).
authors: Rachel A
authors: RA
authors: Annunziato
authors: Fordham University, Bronx, New York (RAA, MP, NC), Icahn School of Medicine at Mount Sinai, New York, (RAA, KK, CB, HH, VN, JS), Westchester Medical Center and New York Medical College, Valhalla, New York (RM).
authors: Meera
authors: M
authors: Parbhakar
authors: Fordham University, Bronx, New York (RAA, MP, NC), Icahn School of Medicine at Mount Sinai, New York, (RAA, KK, CB, HH, VN, JS), Westchester Medical Center and New York Medical College, Valhalla, New York (RM).
authors: Kathryn
authors: K
authors: Kapoor
authors: Fordham University, Bronx, New York (RAA, MP, NC), Icahn School of Medicine at Mount Sinai, New York, (RAA, KK, CB, HH, VN, JS), Westchester Medical Center and New York Medical College, Valhalla, New York (RM).
authors: Robyn
authors: R
authors: Matloff
authors: Fordham University, Bronx, New York (RAA, MP, NC), Icahn School of Medicine at Mount Sinai, New York, (RAA, KK, CB, HH, VN, JS), Westchester Medical Center and New York Medical College, Valhalla, New York (RM).
authors: Nicole
authors: N
authors: Casey
authors: Fordham University, Bronx, New York (RAA, MP, NC), Icahn School of Medicine at Mount Sinai, New York, (RAA, KK, CB, HH, VN, JS), Westchester Medical Center and New York Medical College, Valhalla, New York (RM).
authors: Corinne
authors: C
authors: Benchimol
authors: Fordham University, Bronx, New York (RAA, MP, NC), Icahn School of Medicine at Mount Sinai, New York, (RAA, KK, CB, HH, VN, JS), Westchester Medical Center and New York Medical College, Valhalla, New York (RM).
authors: Hilary
authors: H
authors: Hotchkiss
authors: Fordham University, Bronx, New York (RAA, MP, NC), Icahn School of Medicine at Mount Sinai, New York, (RAA, KK, CB, HH, VN, JS), Westchester Medical Center and New York Medical College, Valhalla, New York (RM).
authors: Vinay
authors: V
authors: Nair
authors: Fordham University, Bronx, New York (RAA, MP, NC), Icahn School of Medicine at Mount Sinai, New York, (RAA, KK, CB, HH, VN, JS), Westchester Medical Center and New York Medical College, Valhalla, New York (RM).
authors: Jeffrey
authors: J
authors: Saland
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D055118:Medication Adherence; D016377:Organ Transplantation; D058996:Quality Improvement; D016559:Tacrolimus / Q000008:administration & dosage / Q000627:therapeutic use; D060305:Transition to Adult Care; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus