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Kidney Week

Abstract: SA-PO698

It Takes Two to Tango: Pediatric and Adult Kidney Transplant Providers' Perspectives and Practices for Transition of Care

Session Information

  • Pediatric Nephrology - 2
    October 26, 2024 | Location: Exhibit Hall, Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Alomar, Omar, Washington University in St Louis, St Louis, Missouri, United States
  • Kosmach-Park, Beverly, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Alhamad, Tarek, Washington University in St Louis, St Louis, Missouri, United States
  • Ong, Song Ching, The University of Alabama at Birmingham, Birmingham, Alabama, United States

Group or Team Name

  • On behalf of the AST KPCOP-PCOP Transition of Care Workgroup.
Background

Kidney transplant (KT) recipients aged 17-24 face the highest graft failure risk, coinciding with their transfer to adult care. Healthcare transition (HCT) can help preparing young adults (YA) for adult care, yet practices of American Society of Transplantation (AST) members serving this vulnerable population have not been studied.

Methods

An on-line survey developed by the AST Kidney-Pancreas and Pediatric Communities of Practice was distributed between July 2023 and March 2024.

Results

There were 131 responses: 60 Pediatric Providers (PP) and 71 Adult Providers (AP), mostly US attending physicians (PP 78%, AP 83%). Out of 69 KT centers where UNOS ID was disclosed, 80% had one respondent. Most PP and AP (91%, 84%) agreed that transition is a joint responsibility and valued having a transition program (PP 97%, AP 94%). More PP had transition programs (70% vs 48%), and both groups were familiar with their centers' transition programs (PP 82%, AP 73%). A formal transition policy was often lacking, with AP more likely to lack one (79% vs. 57%, p=0.008). PP were more likely to have a transition coordinator (67% vs 48%). Multidisciplinary transition clinics were rare (PP 27%, AP 23%). Both groups felt Transition Readiness Assessment was key to timing transfer (PP 87%, AP 73%). 62% of PP had no age limit in their centers and would delay transfer if needed. Both cited mental health status, inadequate self-management and self-advocacy skills as significant barriers. Systemic barriers included the YA relationship with PP, fragmentation of adult care, lack of community resources, and staffing/training issues. Only 19% of AP felt YA were well-prepared for transfer, few continued transition training post-transfer (15%). Outcome measures were tracked by 34% of PP and 42% of AP. Feedback from YA/caregivers was rarely obtained by PP (24%/18%) or AP (37%/24%).

Conclusion

This is the first AST survey on AP and PP perspectives regarding HCT. PP and AP endorse transition as a collaborative process and share similar concerns on barriers to successful HCT. With increased awareness of HCT’s importance for improving outcomes, efforts should focus on program development starting with the pediatric team and continued into young adulthood post-transfer, both systemically and locally.