Transitional Care and Adherence of Adolescents and Young Adults After Kidney Transplantation in Germany and Austria: A Binational Observatory Census Within the TRANSNephro Trial

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.

FIGURE 1

Comparison of frequency of actual transfer age of 119 patients from 2011 to 2012 and rated age by pediatric nephrologist in the questionnaire.

FIGURE 2

Distribution of health care providers transferred to in 2011 to 2012.

FIGURE 3

A total of 25 patients with increased creatinine levels ≥20% as compared to baseline: course of serum creatinine levels within the final year under pediatric health care. Dotted lines indicate the 3 patients who restarted dialysis due to progressive graft failure. ^∗On dialysis at final pediatric visit, ^∗∗Working cimino fistula/dialysis planned at final pediatric visit.

FIGURE 4

Coefficient of variation (CoV%) of immunosuppressive trough levels as surrogate parameter for medication adherence: distribution in 119 patients. The lines mark the CoV% above which it was statistically significantly associated with an increased risk for acute rejections in previous studies: dotted line at 33%, and at 39%,^, line at 41%.