373 A Systematic Review of Transitional Care Models in Paediatric Renal Transplant Recipients

Abstract

<h3></h3> Adolescence is a time of significant change and challenge for clinicians, parents, and patients. The Paediatrician must ensure patients have the necessary skills and knowledge required to function as an individual, with autonomy and self-care. It is well established that adolescent renal transplant recipients have a high incidence of acute allograft rejection and loss.¹ The transfer from paediatric to adult care carries an increased risk of graft-related complications attributable to a multitude of reasons, particularly non-adherence to immunosuppressant medicines and poor attendance at scheduled appointments.^2-6 We aim to present a summary of published, peer-reviewed transitional care models for adolescent renal transplant recipients with a description of their respective approaches. A systematic review was performed, in a methodology outlined by the PRISMA guidelines.⁷ MEDLINE OVID &amp; EMBASE databases were searched for studies that outlined valid, replicable models pertaining to transitional care of paediatric renal transplant recipients between 1946 and Q1 2021. No language restrictions were applied and the reference lists of selected articles were also perused for further eligible studies. Two investigators assessed all studies for eligibility and independently performed data extraction, any discrepancies were settled by consensus. A total of 1,114 abstracts were identified, which was reduced to 1,020, upon removal of duplicates yielded by the respective searches. We also consulted experts in the field for further eligible articles. A total of 49 articles were deemed appropriate for full-text review and critical appraisal. Eight articles were included in qualitative synthesis. Data were extracted from all included models in an endeavour to compare the approach taken in each respective case as follows: Country; clinical setting; transition facilitators; age at first transition clinic; age at transition. Despite the well-established need for good transitional care in paediatric solid-organ transplant recipients, models tailored specifically for renal transplant recipients are few in number. Amongst those present, there is a notable degree of heterogeneity in approach. Further research and validation studies of these models are required, to ascertain the most efficacious method of providing effective transitional care to these patients. <h3>References</h3> Dobbels F, Ruppar T, De Geest S, Decorte A, Van Damme-Lombaerts R, Fine RN. Adherence to the immunosuppressive regimen in pediatric kidney transplant recipients: A systematic review. <i>Pediatr Transplant</i> 2010;14:603–613. Keith DS, Cantarovich M, Paraskevas S, et al. Recipient age and risk of chronic allograft nephropathy in primary deceased donor kidney transplant. <i>Transpl Int</i> 2006;19:649–656. Dew MA, Dabbs AD, Myaskovsky L, et al. Meta-analysis of medical regimen adherence outcomes in pediatric solid organ transplantation. <i>Transplantation</i> 2009;88:736–746. Watson AR. Non-compliance and transfer from pediatric to adult transplant unit. <i>Pediatr Nephrol</i> 2000;14:469– 472. Van Arendonk KJ, Boyarsky BJ, Orandi BJ, et al. National trends over 25 years in pediatric kidney transplant outcomes. Pediatrics 2014;133(4):594- 601. Crowley R, Wolfe I, Lock K, McKee M. Improving the transition between paediatric and adult healthcare: A systematic review. <i>Arch Dis Child</i> 2011;96(6): 548–553. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. <i>PLoS Med</i> 2009;6(7):e1000097. doi:10.1371/journal.pmed1000097