Pediatric-to-Adult Kidney Transplant Transition Clinic in a Single Center: 3-Year Experience

Background: The transition of adolescents from child-centered to adult-oriented health care systems is a complex phenomenon. It is unique for each individual, affected by demographic, personal, ecological factors, as well as degree and specific features of one’s disease. Failure of proper transition in kidney transplant (KT) recipients can lead to medical non-adherence, and subsequent loss of graft and return to dialysis. Methods: We present the framework and findings of the KT Transition clinic at an academic center serving predominantly American Indian and Hispanic population. The clinic consists of a multi-disciplinary team including a lead nephrologist, nurse, pharmacist, social worker, dietician, and psychologist. Regular transition care meetings are conducted between pediatric and adult transplant teams to discuss each eligible patient at length, to understand the medical and social history, as well as to identify any potential barriers for successful transition which can be addressed in a timely and efficient manner. Pre-transition stage occurs at ages 14- 18 years, under the care of pediatric team, where the individual and caregivers are assessed for readiness to transition. Active transition stage starts at 18-21 years age and management is collaborative between the pediatric and adult teams. Complete transition to adult care happens with consensus among the patient, caregivers, and providers. These KT recipients are followed in the transition clinic for up to 26 years age with routine labs and office visits at least every 3 months. Results: Since the re-establishment of the transition process and protocols in January 2021 and until December 2023, we have managed about 30 patients in the clinic with majority identifying as Hispanics (76%). Compliance with clinic visits has increased and remained consistently above 85%. Three out of 4 allograft failures were noted due to biopsy-proven chronic rejection, with none in the past year. Conclusion: We report improved patient compliance and graft outcomes in young adult KT recipients in a single center, achieved through a standardized transition protocol and efficient crosstalk between pediatric and adult provider teams.