NYMC Faculty Publications

Can Transition to Adult Care for Transplant Recipients be Improved by Intensified Services While Patients are Still in Pediatrics?

Author Type(s)

Faculty

DOI

10.7182/pit2015599

Journal Title

Progress in Transplantation

First Page

236

Last Page

242

Document Type

Article

Publication Date

9-1-2015

Department

Pediatrics

Keywords

Adolescent, Adolescent Health Services, Female, Humans, Immunosuppressive Agents, Male, Medication Adherence, Organ Transplantation, Quality Improvement, Tacrolimus, Transition to Adult Care, Young Adult

Disciplines

Medicine and Health Sciences

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).

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