Single-Center Experience with Transition from Pediatric to Adult Transplant Care, 2016-2021

Background: Transition from pediatric to adult care is a high-risk period for graft loss in young adults with kidney transplant. Though social determinants of health are known to influence outcomes, institution-specific risk factors remain poorly characterized. Methods: Retrospective chart review of patients seen by pediatric transplant at University of Michigan who transitioned to adult care between 2016–2021. Data included demographics, clinical outcomes, lab values, and appointment attendance. eGFR calculated using CKiD U25 equation. Results: Image 1 describes cohort (N=41). 16/41 (39%) required dialysis within 3 years of transition. Image 2 explores risk factors for graft loss. While many returning to dialysis had elevated cystatin C at transition, others had preserved function with subsequent loss (Panel A). No-show appointments (Panel B) and missed monthly labs (Panel C) in the 2 years prior to transition and out-of-range tacrolimus levels in the year prior to transition (Panel D) were all more common in those who returned to dialysis. No correlation is seen between missed labs and tacrolimus levels out of range (Panel E). Conclusion: This analysis underscores transition challenges, including frequent graft loss, target drug levels out of range, and care gaps. Lack of correlation between missed labs and tacrolimus levels out of range suggests a complex relationship between monitoring and adherence. Further data analyses will refine identification of modifiable risk factors to guide interventions to improve outcomes in this at-risk population.