Adolescent paediatric transplant patients’ experiences of transition to adult services

Abstract

Background: Transition of adolescents from paediatric to adult health services is an important aspect of caring for young people with chronic diseases. Successful transition of adolescents living with a transplant is critical for long-term survival into adulthood. This qualitative study explored the lived experience of adolescents in a South African setting following their planned and supported transition process.Aim: To explore the lived experience of transition for adolescents who had received a renal or liver transplant as a child, from paediatric to adult transplant services in the public health sector.Setting: Cape Town, South Africa.Method: Six purposively sampled adolescents, who had participated in a planned transition from a tertiary level children’s hospital to the affiliated adult hospital, were interviewed in the setting and language of their choice. The transcribed interviews were analysed using an interpretative phenomenological analysis (IPA) approach.Results: Five themes emerged: living with uncertainty in a changing world; being known, not knowing, and knowing; ambivalent relationships; the journey of loss; and being heard. Pre-transition planning, support groups, and consistency of clinicians within an accepting environment facilitated the adolescents’ individuation and acceptance of self-care responsibility.Conclusion: Carefully planned, collaborative preparation and implementation of a facilitated psycho-supportive intervention for transition can facilitate adolescent cooperation and adherence, minimise the risk of psychological and medical sequelae, and support the adolescent in adapting to living with a transplant as an adult.Contribution: This study offers insight into the importance of planned and supported transitional care of adolescents living with an organ transplant.

Pregnancy after kidney and liver transplantation

“…Most centres lack a formal transition programme from paediatric to adult care at the time of puberty, which may make these discussions particularly difficult. [19,20] Adolescent female patients may be faced with a new and unfamiliar healthcare team and a system less equipped to manage the complex care of adolescent patients (aged 10 -19 years). [21] Adolescence is a high-risk period for graft rejection; one SA study demonstrated a graft failure rate of 74.5% in adolescent renal transplant patients, although the majority (62.2%) occurred in male patients.…”