TY - JOUR
T1 - Can transition to adult care for transplant recipients be improved by intensified services while patients are still in pediatrics?
AU - Annunziato, Rachel A.
AU - Parbhakar, Meera
AU - Kapoor, Kathryn
AU - Matloff, Robyn
AU - Casey, Nicole
AU - Benchimol, Corinne
AU - Hotchkiss, Hilary
AU - Nair, Vinay
AU - Saland, Jeffrey
N1 - Publisher Copyright:
© 2015 NATCO, The Organization for Transplant Professionals.
PY - 2015
Y1 - 2015
N2 - 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).
AB - 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).
UR - http://www.scopus.com/inward/record.url?scp=84973594973&partnerID=8YFLogxK
U2 - 10.7182/pit2015599
DO - 10.7182/pit2015599
M3 - Article
C2 - 26308783
AN - SCOPUS:84973594973
SN - 1526-9248
VL - 25
SP - 236
EP - 242
JO - Progress in Transplantation
JF - Progress in Transplantation
IS - 3
ER -