Adolescent organ transplant recipients need support as they transition to adult care
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Adolescent and young adult organ transplant recipients require supportive clinical care when transitioning to adult health care, according to data published in Pediatric Transplantation.
Further, successful retention in adult health care showed a stronger correlation to improved clinical outcomes compared with initial engagement.
“Clinic attendance, particularly at the first appointment in adult care, is largely considered the indicator of successful transition of care. However, there are several reasons why this may not be the most representative metric of responsibility or engagement in adult care. This is particularly important for organ transplant recipients, as the period of adolescence and young adulthood associated with transition is associated with high rates of medication nonadherence, organ rejection and death,” Kelly E. Rea, MS, from the department of psychology at the University of Georgia, told Healio. “To further understand this, I was mainly interested in asking the question, is it enough to walk through the door to initiate that first contact with adult providers, and what does follow-up look like related to longer-term medical outcomes?”
Rea and colleagues evaluated health care utilization, medical outcomes and transition success among 49 adolescent and young adult heart, kidney or liver recipients (average age, 20.62 years; 55% men; 53% white). All patients were recently transitioned to adult health care.
Researchers considered primary outcomes to be initial engagement in adult health care within 6 or 12 months of last pediatric appointment and retention in adult health care over 3 years following last pediatric appointment.
Using growth curve modeling, researchers measured change in attendance over time.
Among the participants, 29 attended their first adult appointment within 6 months of transfer. However, 38 participants attended their first adult appointment within 12 months of transfer. In the first 3 years following transfer, 36 participants attended an average of at least one appointment per year and were considered to have been retained in adult health care.
Analyses revealed that compared with initial engagement, successful retention in health care was related to more improved clinical outcomes. Researchers identified significant declines in appointment attendance over 3 years and suggested clinical care teams find ways to support adolescents and young adults after transfer to adulthood.
“This study suggests it’s not enough to just get them through the door — it is also important to retain them in adult care over time. While it is critical to attend the first appointment, it is also essential that patients are appropriately following up,” Rea told Healio. “From a clinical perspective, this suggests we should be paying specific attention to providing necessary supports within clinics to promote retention in adult care. For example, this could include targeted, individualized follow ups with those who have not scheduled appointments or providing psychosocial supports for the specific developmental needs of young adults during transition, like navigating health insurance.”
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