Smoothing Things over: The Transition from Pediatric to Adult Care for Kidney Transplant Recipients

Abstract

Background Transition is a planned movement of adolescents with chronic physical and medical conditions from child-centered to adult-oriented healthcare systems as opposed to a purely administrative event. Objective To evaluate the transition of pediatric kidney transplant recipients to the adult service at Guy's Hospital between 2000 and 2001 as compared with best practice from the literature, and to establish client satisfaction with the process. Design Data were collected by means of a retrospective review of case notes, clinician interview, and a patient satisfaction questionnaire, and analyzed by a single reviewer. Main Outcome Measures Sixteen cases were analyzed with respect to their progress over the period of 1 year before and 1 year after transfer by looking at markers of adherence; a clinician's subjective assessment of overall graft stability before, during, and after transfer; and whether subjects chose to attend the transitional clinic. Results There was no qualitative difference in adherence or control among the patients who experienced the transitional clinic and those who did not. Patients who were considered stable and adherent before transition were not necessarily the same following transfer and vice versa. Patients who experienced the transitional clinic were not more satisfied as a group, although 9 of 11 thought their transition was “OK” or better. Conclusion This is an extremely challenging area of pediatric nephrology; all patients need a high level of support. Services cannot be targeted to high-risk groups.