G487(P) Improving renal allograft survival by introducing a multicomponent transition programme for paediatric renal transplant recipients

Abstract

Background Adolescence is a vulnerable period for paediatric renal transplant recipients (RTR), with many losing their allografts within years of transferring to adult care. A transition programme was developed to better equip RTR for adulthood. It features a five-year education framework with a phased-handover to the adult team over two years via joint-clinics. Aims To evaluate the impact of the transition programme on post-transfer renal allograft survival and to evaluate the patient education arm of the transition programme. Methods A retrospective cohort study of RTR who transferred from a paediatric centre before the transition programme was introduced (non-transition cohort) and RTR who transferred via the transition programme (transition cohort). RTR who transferred to one of four adult centres between January 1999 and January 2014 were followed up to their first four years in adult care. Data on renal allograft survival and therapeutic drug monitoring of immunosuppressive medications were collected. Additionally, RTR currently on the programme approaching transfer completed a questionnaire to indicate self-care competencies they possessed and post-transfer RTR were asked if the transition programme helped them develop said competencies. Results 106 (69 non-transition, 37 transition) RTR were followed-up. Non-transition RTR were 2.76 times more likely to lose their allografts during their first four years in adult care; when controlling for donor type (live/deceased), prior number of renal transplants and the time (days) post–transplant prior transferring (95% CI = 0.808 – 9.51; p = 0.1). The transition cohort also had on average 21% (65% vs. 44%) more of their trough levels within their therapeutic target levels (95% CI = 2.5–38.4%; p = 0.03). 41 RTR at the paediatric centre and 7 post-transfer RTR completed the questionnaire. Responses indicated patients possessed most competencies, except for managing administrative tasks relating to their care. Over 50% of post-transfer RTR reported the programme helped them develop all, but one, competencies they possessed. Conclusion We report the largest follow-up to-date of RTR from a single centre evaluating a novel, multicomponent transition programme. Our data indicates a longitudinal transition programme with a phased-handover via joint–clinics is positively associated with post-transfer renal allograft survival.