Speaker: Streamline transition of patients with kidney transplant to general nephrologists
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Key takeaways:
- A successful transition should be framed positively with clear roles and responsibilities.
- More centers graduate patients than not, with half using a joint care approach.
BALTIMORE — Successfully transitioning patients with a failed kidney transplant back to a general nephrologist requires a streamlined and tailored approach, a speaker said here.
Neeraj Singh, MD, of the John C. McDonald Regional Transplant Center in Shreveport, Louisiana, discussed transition strategies and challenges at the Renal Physicians Association Annual Meeting. “This is a very understudied topic [where there is not] much research and no published writings,” Singh said.
Researchers analyzed data from a national survey of U.S. transplant centers to outline post-transplant transition tactics and rationale.
For a successful changeover of care, Singh said that nephrologists should focus on transplant center care program outcomes and incentives; patient considerations like choice of center, proximity and the need for additional support such as insurance assistance; as well as the referring nephrologist’s experience. Using a shared care model, patients should also be seen by a transplant physician while alternating follow-ups with the referring nephrologist.
During a transition, Singh added, caregivers on each side should know drug interactions, how often to order labs, have access to center resources including electronic medical records, be aware of medical coverage and recognize post-transplant complications.
More centers graduate patients than not, with half of using a joint care approach and one-third reporting full return to the referring nephrologist, according to the survey findings. Centers that do not graduate patients to a local nephrologist commonly report the desire to maintain continuity of care or patient choice as to the reasoning, Singh said.
The percentage of patients lost to follow-up is 10% to 50%, Singh said. If a patient returns to the center after graduating a program, it is often due to worsening renal function, followed by a malignancy.
Overall, a successful transition should be framed positively and have a clear delineation of roles and responsibilities, Singh said. “It is important to develop a framework that ... meets the needs of all stakeholders — patients, transplant centers and general nephrologists.”
Reference:
Singh N. Managing transition of care. Presented at: Renal Physicians Association Annual Meeting; April 11-14, 2024; Baltimore.
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Singh N. Managing transition of care. Presented at: Renal Physicians Association Annual Meeting; April 11-14, 2024; Baltimore.
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