Kidney transplant survival in pediatric and young adults

Kiberd, James; Acott, Phil; Kiberd, Bryce A.

doi:10.1186/1471-2369-12-54

Cited by 35 publications

(23 citation statements)

References 19 publications

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“…Earlier reports support the concept of worsening graft survival and medication adherence following transfer of care from pediatric to adult transplant services. On the contrary, more recent investigations did not find a difference between rates of acute allograft rejection and graft loss before and after transfer . To clarify the possible effect of transfer on the well‐being of transplant patients, it may be worth exploring not only hard outcomes, such as graft loss, but also some intermediate outcomes, such as adherence.…”

mentioning

confidence: 99%

Medication adherence in the transition of adolescent kidney transplant recipients to the adult care

Akchurin

Melamed

Hashim

et al. 2014

Pediatric Transplantation

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Non-adherence is common in adolescent and young adult kidney transplant recipients, leading to adverse graft outcomes. The aim of this study was to determine if adherence to immunosuppressant medications changes during transition from a pediatric to an adult program within the same transplant center. Adherence was assessed for a period of two years before and two years after the transfer. Sub-therapeutic trough levels of serum tacrolimus and level variability were used as measures of adherence. Twenty-five patients were transitioned between 1996 and 2011 at the median age of 22.3 [IQR 21.6 to 23.0] years. Young adults 21 to 25 years of age (n=26) and non-transitioned adolescents 17 to 21 years of age (currently followed in the program, n=24 and those that lost their grafts prior to the transfer, 22) formed the comparison groups. In the transitioned group, adherence prior to the transfer was not significantly different from the adherence after the transfer (p=0.53). The rate of non-adherence in the group of non-transitioned adolescents who lost their grafts (68%) was significantly higher than in the transitioned group (32%, p=0.01). In the group of young adults, adherence was not significantly different from the transitioned group (p=0.27). Thus, transition was not associated with differences in medication adherence in this single-center study. Large-scale studies are needed to evaluate the national data on medication adherence after transfer.

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confidence: 99%

Medication adherence in the transition of adolescent kidney transplant recipients to the adult care

Akchurin

Melamed

Hashim

et al. 2014

Pediatric Transplantation

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“…However, this may simply reflect higher risks during emerging adulthood [29,30]. Even emerging adults cared for exclusively in an adult-oriented care environment have a heightened risk of graft failure [31]. Likely, a mismatch between the needs of individuals in the high risk age period and the care environment results in the high rate of adverse outcomes following transfer of care: individuals transferred at \21 years of age had a 57 % higher risk of graft failure compared with those transferred at C21 years [6 • ].…”

Section: Medical Outcomesmentioning

confidence: 99%

Improving the Transition to Adult Care for Young People with Chronic Kidney Disease

Foster

Bell

2015

Curr Pediatr Rep

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The transition from pediatric-to adult-oriented care typically occurs during emerging adulthood, a developmental stage during which the risks of poor treatment adherence and adverse outcomes are elevated. Inadequate support during this change in care environment may augment the risks. With a focus on chronic kidney disease, we will briefly review the evidence linking transition from pediatric-to adult-oriented care to adverse medical, social, and quality of life outcomes, and outline potential reasons for the associations between transition and adverse outcomes. Then we will summarize the recent literature on potential interventions to improve the transition from pediatric-to adult-oriented care. We will examine strategies to improve (1) preparation for transition (including positive youth development, peer mentoring, education, and self-care skill development), (2) the transition process itself (including different models of transition care), and (3) the care structures/systems available for emerging adults within the adult-oriented care environment (including expectations of young people and parents, adaptation of adult care to the emerging adult, and improved education of adult care providers in issues of importance to emerging adults). The perspectives of patients, parents, and healthcare providers will be considered throughout.

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“…Interestingly, Kiberd et al. found that transfer per se was not a problem point for renal transplant recipients, but that vulnerability to poor outcomes increases during the overall time period of transition. This review focuses on transition broadly as well as the specific transfer from pediatrics.…”

Section: Transition Among Emerging Adults With a Solid Organ Transplantmentioning

confidence: 99%

An empirically based practice perspective on the transition to adulthood for solid organ transplant recipients

Annunziato

Freiberger

Martin

et al. 2014

Pediatric Transplantation

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Preparing patients for transitioning to self-managed care and subsequently transferring to the adult healthcare system has become a critical process for clinicians working with pediatric transplant recipients. This paper reviews several barriers to a successful transition. These include patient barriers, caregiver barriers, and considerations within pediatric and adult centers. To date, few approaches for improving the transition process have been empirically tested. This review details studies that have examined possible models including usage of a transition coordinator and transition clinics. Recommendations are offered to promote an optimal transition including the importance and content of preparation, assessing and addressing transition readiness, insuring the involvement of all stakeholders, and finally, at minimum providing services during the transfer period. Future directions are offered aiming to advance this important area of investigation.

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Kidney transplant survival in pediatric and young adults

Cited by 35 publications

References 19 publications

Medication adherence in the transition of adolescent kidney transplant recipients to the adult care

Medication adherence in the transition of adolescent kidney transplant recipients to the adult care

Improving the Transition to Adult Care for Young People with Chronic Kidney Disease

An empirically based practice perspective on the transition to adulthood for solid organ transplant recipients

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