Risk Factors for Graft Loss in Pediatric Renal Transplant Recipients After Transfer of Care.
BACKGROUND
Improvements in transplantation have increased the survival of children after kidney transplantation. These patients have complex needs, and the current medical system is not prepared to effectively transfer the care of these individuals from pediatric to adult health-care systems. Too often, transfer occurs during moments of crisis and is associated with poor outcomes.


OBJECTIVE
The aim of this study was to use a national database, the Scientific Registry of Transplant Recipients, to test the hypothesis that the increased risk of graft loss after transfer of care (from pediatric to adult services) for young adult kidney transplant recipients over a 2- to 3-year posttransfer follow-up period was related to these posttransfer risk factors (medication noncompliance, acute rejection, insurance status).


METHODS
A retrospective, longitudinal, correlational design using secondary data was used to evaluate the transfer of care of 250 kidney transplant recipients (ages 16-25).


RESULTS
Seventy-seven (30.8%) individuals lost their graft within 3 years after transfer of care. Medication noncompliance, acute rejection, and serum creatinine >2.0 mg/dL at transfer were significant predictors of graft loss after accounting for multiple other factors.


CONCLUSIONS
These individuals are at risk for graft loss after transfer of care and may benefit from increased personalized care during this risky period.
1 Department of Pediatrics, University of Virginia Health System, Charlottesville, VA, USA.|2 School of Nursing, University of Virginia, Charlottesville, VA, USA.
Bethany
B
Coyne
1 Department of Pediatrics, University of Virginia Health System, Charlottesville, VA, USA.|2 School of Nursing, University of Virginia, Charlottesville, VA, USA.
Patricia J
PJ
Hollen
3 Department of Public Health Sciences, School of Medicine, University of Virginia Health System, Charlottesville, VA, USA.
Guofen
G
Yan
4 Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA.
Kenneth
K
Brayman
D002648:Child; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D012189:Retrospective Studies; D012307:Risk Factors
acute rejection; adolescence; graft loss; noncompliance; serum creatinine; transfer of care