Transitional Care and Adherence of Adolescents and Young Adults After Kidney Transplantation in Germany and Austria

Abstract

Transition from child to adult-oriented care is widely regarded a challenging period for young people with kidney transplants and is associated with a high risk of graft failure.We analyzed the existing transition structures in Germany and Austria using a questionnaire and retrospective data of 119 patients transferred in 2011 to 2012.Most centers (73%) confirmed agreements on the transition procedure. Patients’ age at transfer was subject to regulation in 73% (18 years). Median age at transition was 18.3 years (16.5–36.7). Median serum creatinine increased from 123 to 132 μmol/L over the 12 month observation period before transfer (P = 0.002). A total of 25/119 patients showed increased creatinine ≥20% just before transfer. Biopsy proven rejection was found in 10/119 patients. Three patients lost their graft due to chronic graft nephropathy.Mean coefficient of variation (CoV%) of immunosuppression levels was 0.20 ± 0.1. Increased creatinine levels ≥20% just before transfer were less frequently seen in patients with CoV < 0.20 (P = 0.007).The majority of pediatric nephrology centers have internal agreements on transitional care. More than half of the patients had CoV of immunosuppression trough levels consistent with good adherence. Although, 20% of the patients showed increase in serum creatinine close to transfer.

Impaired Microcirculation in Children After Kidney Transplantation: Everolimus Versus Mycophenolate Based Immunosuppression Regimen

“…The sample size of this pilot study represents about 10% of children aged 6-18 with working kidney transplant in Germany [38,39]. In this matched cross-sectional study we found significant differences in micro-vascular parameters between patients treated with either an EVR-based regime or a standard immunosuppressive treatment.…”

Treatment Adherence in Young Adults Receiving Kidney Replacement Therapy

“…The use of transition of care facilities should be implemented to provide a smooth transition to self-care. Research in the young adults and adolescents population and the use of transition of care for kidney disease has become promising in recent years (4).…”

Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients

“…11 More effective educational programs, better engagement of younger recipients, and use of long-acting parenteral immunosuppressive therapies and once-daily drugs can be used to reduce the complexity of immunosuppressive regimens and improve adherence. 74,86,95,271 The long-term use of belatacept significantly reduces the risk of de novo DSAs compared with cyclosporine A-based immunosuppression. 271 However, it is still not fully clear whether the decreased incidence of de novo DSAs arises from better adherence, the drug's ability to block the second signal and T-cell follicular helper cells, or both factors.…”