title: Transitional Care and Adherence of Adolescents and Young Adults After Kidney Transplantation in Germany and Austria: A Binational Observatory Census Within the TRANSNephro Trial.
abstract: Transition from child to adult-oriented care is widely regarded a challenging period for young people with kidney transplants and is associated with a high risk of graft failure. We analyzed the existing transition structures in Germany and Austria using a questionnaire and retrospective data of 119 patients transferred in 2011 to 2012. Most centers (73%) confirmed agreements on the transition procedure. Patients' age at transfer was subject to regulation in 73% (18 years). Median age at transition was 18.3 years (16.5-36.7). Median serum creatinine increased from 123 to 132 μmol/L over the 12 month observation period before transfer (P = 0.002). A total of 25/119 patients showed increased creatinine ≥ 20% just before transfer. Biopsy proven rejection was found in 10/119 patients. Three patients lost their graft due to chronic graft nephropathy.Mean coefficient of variation (CoV%) of immunosuppression levels was 0.20 ± 0.1. Increased creatinine levels ≥ 20% just before transfer were less frequently seen in patients with CoV < 0.20 (P = 0.007). The majority of pediatric nephrology centers have internal agreements on transitional care. More than half of the patients had CoV of immunosuppression trough levels consistent with good adherence. Although, 20% of the patients showed increase in serum creatinine close to transfer.
authors.affiliation: From the Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School (MK, JP, JD, LP); German Society of Transition Medicine, Hannover (MK, MO, SM, LP); Division of Pediatric Nephrology, Center for Child and Adolescent Medicine, Heidelberg University Hospital, Heidelberg (DB, SR); Department of Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Hannover (M-LD); Berliner Transitions Programm (BTP), DRK-Kliniken (German Red Cross hospitals) Berlin Westend (SM); Department of Pediatric Nephrology, Charité, Berlin (JT); University Hospital of Bonn, Bonn (BH); Department of Pediatrics II, Essen University Hospital, Essen (AB); Childrens' Hospital, University of Erlangen, Erlangen (WR); KfH Center of Pediatric Nephrology, Clementine Childrens' Hospital, Frankfurt (MH); Department of General Pediatrics, Adolescent Medicine and Neonatology, Freiburg University Hospital, Freiburg (MP); University Childrens' Hospital Eppendorf, Hamburg (MJK); University Childrens' Hospital, Jena (UJ); Pediatric Nephrology, University Hospital of Cologne, Cologne (CT); University Childrens' Hospital (KD); KfH Center of Pediatric Nephrology, St. Georg Hospital, Leipzig (SH); KfH Center of Pediatric Nephrology, University Hospital of Marburg, Marburg (GK); KfH Center of Pediatric Nephrology, Childrens' Hospital Memmingen, Memmingen (HF); University Childrens' Hospital Münster (BK); KfH Center of Pediatric Nephrology, University Childrens' Hospital München Schwabing (CM); Dr. von Haunersches Kinderspital, Ludwigs Maximilian University, Munich (BL-S); Childrens' Hospital, Olgahospital Klinikum Stuttgart, Stuttgart (BR); University Childrens' Hospital Tübingen, Tübingen (HB); University Childrens' Hospital, Rostock, Germany (HS); University Childrens' Hospital, Vienna, Austria (KH-R); and KfH Center of Nephrology, Hospitals of the Hannover Region, Hannover, Germany (RB).
authors.forename: Martin
authors.initials: M
authors.lastname: Kreuzer
authors.forename: Jenny
authors.initials: J
authors.lastname: Prüfe
authors.forename: Martina
authors.initials: M
authors.lastname: Oldhafer
authors.forename: Dirk
authors.initials: D
authors.lastname: Bethe
authors.forename: Marie-Luise
authors.initials: ML
authors.lastname: Dierks
authors.forename: Silvia
authors.initials: S
authors.lastname: Müther
authors.forename: Julia
authors.initials: J
authors.lastname: Thumfart
authors.forename: Bernd
authors.initials: B
authors.lastname: Hoppe
authors.forename: Anja
authors.initials: A
authors.lastname: Büscher
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rascher
authors.forename: Matthias
authors.initials: M
authors.lastname: Hansen
authors.forename: Martin
authors.initials: M
authors.lastname: Pohl
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Kemper
authors.forename: Jens
authors.initials: J
authors.lastname: Drube
authors.forename: Susanne
authors.initials: S
authors.lastname: Rieger
authors.forename: Ulrike
authors.initials: U
authors.lastname: John
authors.forename: Christina
authors.initials: C
authors.lastname: Taylan
authors.forename: Katalin
authors.initials: K
authors.lastname: Dittrich
authors.forename: Sabine
authors.initials: S
authors.lastname: Hollenbach
authors.forename: Günter
authors.initials: G
authors.lastname: Klaus
authors.forename: Henry
authors.initials: H
authors.lastname: Fehrenbach
authors.forename: Birgitta
authors.initials: B
authors.lastname: Kranz
authors.forename: Carmen
authors.initials: C
authors.lastname: Montoya
authors.forename: Bärbel
authors.initials: B
authors.lastname: Lange-Sperandio
authors.forename: Bettina
authors.initials: B
authors.lastname: Ruckenbrodt
authors.forename: Heiko
authors.initials: H
authors.lastname: Billing
authors.forename: Hagen
authors.initials: H
authors.lastname: Staude
authors.forename: Krisztina
authors.initials: K
authors.lastname: Heindl-Rusai
authors.forename: Reinhard
authors.initials: R
authors.lastname: Brunkhorst
authors.forename: Lars
authors.initials: L
authors.lastname: Pape
mesh_terms: D000293:Adolescent; D000328:Adult; D001317:Austria; D005260:Female; D005858:Germany; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies; D060305:Transition to Adult Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D007166:Immunosuppressive Agents