title: Benefits of a transfer clinic in adolescent and young adult kidney transplant patients.
abstract: BACKGROUND
  Adolescent and young adult kidney transplant recipients have worse graft outcomes than older and younger age groups. Difficulties in the process of transition, defined as the purposeful, planned movement of adolescents with chronic health conditions from child to adult-centered health care systems, may contribute to this. Improving the process of transition may improve adherence post-transfer to adult care services.
  
  
  OBJECTIVE
  The purpose of this study is to investigate whether a kidney transplant transfer clinic for adolescent and young adult kidney transplant recipients transitioning from pediatric to adult care improves adherence post-transfer.
  
  
  METHODS
  We developed a joint kidney transplant transfer clinic between a pediatric kidney transplant program, adult kidney transplant program, and adolescent medicine at two academic health centers. The transfer clinic facilitated communication between the adult and pediatric transplant teams, a face-to-face meeting of the patient with the adult team, and a meeting with the adolescent medicine physician. We compared the outcomes of 16 kidney transplant recipients transferred before the clinic was established with 16 patients who attended the clinic. The primary outcome was a composite measure of non-adherence. Non-adherence was defined as either self-reported medication non-adherence or displaying two of the following three characteristics: non-attendance at clinic, non-attendance for blood work appointments, or undetectable calcineurin inhibitor levels within 1 year post-transfer.
  
  
  RESULTS
  The two groups were similar at baseline, with non-adherence identified in 43.75 % of patients. Non-adherent behavior in the year post-transfer, which included missing clinic visits, missing regular blood tests, and undetectable calcineurin inhibitor levels, was significantly lower in the cohort which attended the transfer clinic (18.8 versus 62.5 %, p = 0.03). The median change in estimated glomerular filtration rate (eGFR) in the year following transfer was smaller in the group that attended the transition clinic (-0.9 ± 13.2 ml/min/1.73 m(2)) compared to those who did not (-12.29 ± 14.9 ml/min/1.73 m(2)), p = 0.045.
  
  
  CONCLUSIONS
  Attendance at a single kidney transplant transfer clinic was associated with improved adherence and renal function in the year following transfer to adult care. If these changes are sustained, they may improve long-term graft outcomes for adolescent kidney transplant recipients.
authors.affiliation: Division of Nephrology and Department of Medicine, University Health Network, Toronto, Ontario Canada ; Toronto General Hospital, 200 Elizabeth Street, 8N-819, Toronto, Ontario M5G 2C4 Canada.
authors.forename: Rory F
authors.initials: RF
authors.lastname: McQuillan
authors.affiliation: Division of Adolescent Medicine, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario Canada ; Good 2 Go Transition Program, Hospital for Sick Children, Toronto, Ontario Canada ; Hospital for Sick Children, 525 University Avenue, Toronto, Ontario M5G 1X8 Canada.
authors.forename: Alene
authors.initials: A
authors.lastname: Toulany
authors.affiliation: Division of Adolescent Medicine, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario Canada ; The Transplant and Regenerative Medicine Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario Canada ; Good 2 Go Transition Program, Hospital for Sick Children, Toronto, Ontario Canada ; Hospital for Sick Children, 525 University Avenue, Toronto, Ontario M5G 1X8 Canada.
authors.forename: Miriam
authors.initials: M
authors.lastname: Kaufman
authors.affiliation: Division of Nephrology and Department of Medicine, University Health Network, Toronto, Ontario Canada ; Multi-Organ Transplant Program, University Health Network, Toronto, Ontario Canada ; Toronto General Hospital, 585 University Avenue, 11 PMB 185, Toronto, Ontario M5G 2N2 Canada.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Schiff
keywords: Adherence; Health care; Transfer; Transition; Transplant