Abstract: SA-PO048
RISE to Transition: A Structured Transition Protocol for Renal Transplant Recipient Children
Session Information
- Transplantation: Clinical Outcomes
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Raina, Rupesh, Cleveland Clinic Akron General, Broadview Heights, Ohio, United States
- Krishnappa, Vinod, Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, Ohio, United States
Background
The transition from pediatric to adult medical services is an important time in the life of an adolescent or young adult with a renal transplant. Failure to properly transition can lead to medical non-adherence and subsequent loss of graft and/or return to dialysis.
Methods
To establish a locally-adapted, patient-focused, kidney transplant transition program, we implemented the RISE protocol. This was defined by four competency areas: Rise, Insight, Self-Reliance, and Establish; identified through literature review and experience. Seventeen patients (6 female and 11 males, mean age 14.5 yrs), who received a renal transplant in the preceding 2-9 years (mean 5.6 years, median 7), went through transition protocols. The transition process spanned two years to overlap medical care between pediatric nephrologists and key adult physicians and related services. The final transition was completed at 21 years of age.
Results
Adolescents and parents did not differ significantly in their general views and stated that they would appreciate the support provided by a transition program. However, the parents appreciated the support during transfer significantly more than did the adolescents. Eighty five percent of patients and family felt generally well informed of the RISE transition. However, 70% preferred to receive more information about their disease and overall health during their transfer period. When asked for the key person during the transfer, 62% of respondents mentioned the pediatrician, 6% said “others,” and 30% stated that it was the nurses. The relevant issues during transfer were cited as medication (35%), education and employment (27%), disease knowledge (13%), and environment in the adult service (25%).
Conclusion
RISE protocol and its four competency areas are the key to an effective transition to the adult services. Self-reliance and the establishment of healthy choices aim to improve patient autonomy and emotional burden, and to minimize disruptions in their daily lives. Recognition and insight aim to educate the patient in all aspects of their disease. Education about medical, social, vocational/educational, and interpersonal effects of their disease and treatment will help to improve adherence as well as alter patient perspectives of their disease.