The TRANSNephro-study examining a new transition model for post-kidney transplant adolescents and an analysis of the present health care: study protocol for a randomized controlled trial

Kreuzer, Martin; Prüfe, Jenny; Bethe, Dirk; Vogel, Charlotte; Großhennig, Anika; Koch, Armin; Oldhafer, Martina; Dierks, Marie‐Luise; Albrecht, Urs‐Vito; Müther, Silvia; Brunkhorst, Reinhard; Pape, Lars

doi:10.1186/1745-6215-15-505

Cited by 42 publications

(26 citation statements)

References 15 publications

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“…This retrospective study was performed as the first part of the TRANSNephro project to assess the current transition situation in Germany and Austria and provide data on graft function, graft loss rates, and the variation of immunosuppression trough levels. A prospective, randomized, interventional binational multicenter study is the second part of the TRANSNephro project, 15 and patient recruitment has started at the pilot center Hannover in October 2014 and from January to June at the other participating centers. This study will not only provide additional information about allograft nephropathy, acute and chronic rejection, formation of donor specific antibodies and clinical course in the pediatric, and adult nephrology setting, but is the first interventional, prospective, randomized trial in transition with the possibility to prove to which extent a transition program can really improve health.…”

Section: Discussionmentioning

confidence: 99%

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Transitional Care and Adherence of Adolescents and Young Adults After Kidney Transplantation in Germany and Austria

et al. 2015

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Transition from child to adult-oriented care is widely regarded a challenging period for young people with kidney transplants and is associated with a high risk of graft failure.We analyzed the existing transition structures in Germany and Austria using a questionnaire and retrospective data of 119 patients transferred in 2011 to 2012.Most centers (73%) confirmed agreements on the transition procedure. Patients’ age at transfer was subject to regulation in 73% (18 years). Median age at transition was 18.3 years (16.5–36.7). Median serum creatinine increased from 123 to 132 μmol/L over the 12 month observation period before transfer (P = 0.002). A total of 25/119 patients showed increased creatinine ≥20% just before transfer. Biopsy proven rejection was found in 10/119 patients. Three patients lost their graft due to chronic graft nephropathy.Mean coefficient of variation (CoV%) of immunosuppression levels was 0.20 ± 0.1. Increased creatinine levels ≥20% just before transfer were less frequently seen in patients with CoV < 0.20 (P = 0.007).The majority of pediatric nephrology centers have internal agreements on transitional care. More than half of the patients had CoV of immunosuppression trough levels consistent with good adherence. Although, 20% of the patients showed increase in serum creatinine close to transfer.

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Section: Discussionmentioning

confidence: 99%

“…22988897), and the study protocol was published December 2014. 15 The TRANSNephro-study consists of 2 parts. Part 1, the analysis of the existing mode of transition is reported in the present paper.…”

Section: Methodsmentioning

confidence: 99%

Transitional Care and Adherence of Adolescents and Young Adults After Kidney Transplantation in Germany and Austria

et al. 2015

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“…The TWG used as a framework previously published recommendations from the American Academy of Pediatrics, the American Epilepsy Society, and The Provincial (Ontario) Council for Maternal and Child Health . In addition, several publications outlining the principles of transition for patients with a variety of chronic pediatric diseases or specifically for patients with epilepsy were reviewed. Most of these papers correctly emphasize the need for multidisciplinary transition clinics.…”

Section: How To Improve the Exit From The Pediatric And Entry Into Tmentioning

confidence: 99%

Epilepsy: Transition from pediatric to adult care. Recommendations of the Ontario epilepsy implementation task force

et al. 2017

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The transition from a pediatric to adult health care system is challenging for many youths with epilepsy and their families. Recently, the Ministry of Health and Long-Term Care of the Province of Ontario, Canada, created a transition working group (TWG) to develop recommendations for the transition process for patients with epilepsy in the Province of Ontario. Herein we present an executive summary of this work. The TWG was composed of a multidisciplinary group of pediatric and adult epileptologists, psychiatrists, and family doctors from academia and from the community; neurologists from the community; nurses and social workers from pediatric and adult epilepsy programs; adolescent medicine physician specialists; a team of physicians, nurses, and social workers dedicated to patients with complex care needs; a lawyer; an occupational therapist; representatives from community epilepsy agencies; patients with epilepsy; parents of patients with epilepsy and severe intellectual disability; and project managers. Three main areas were addressed: (1) Diagnosis and Management of Seizures; 2) Mental Health and Psychosocial Needs; and 3) Financial, Community, and Legal Supports. Although there are no systematic studies on the outcomes of transition programs, the impressions of the TWG are as follows. Teenagers at risk of poor transition should be identified early. The care coordination between pediatric and adult neurologists and other specialists should begin before the actual transfer. The transition period is the ideal time to rethink the diagnosis and repeat diagnostic testing where indicated (particularly genetic testing, which now can uncover more etiologies than when patients were initially evaluated many years ago). Some screening tests should be repeated after the move to the adult system. The seven steps proposed herein may facilitate transition, thereby promoting uninterrupted and adequate care for youth with epilepsy leaving the pediatric system.

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“…Um dieses Problem zu adressieren, werden in jüngster Zeit immer größere Bemühungen unternommen. Angelehnt an das Berliner TransitionsProgramm, welches auf den Übergang von Jugendlichen und jungen Erwachsenen mit unterschiedlichen chronischen Erkrankungen in die Erwachsenenmedizin fokussiert, stellen Kreuzer et al [40] eine Studie vor, in der ein Transitionsmodell für nierentransplantierte Patienten erprobt werden soll, das den Einsatz von Fallmanagern und von speziellen Apps beinhaltet.…”

Section: Transitionsphaseunclassified

Immunsuppressiva-Adhärenz nach Transplantation

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et al. 2018

Psychother Psych Med

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Organ transplantation is the best and to some extent only option for many patients with chronic organ failure. Usually after successful transplantation patients experience a significant improvement of their condition. Nevertheless, they are not cured but still chronically ill. Living with an organ transplant requires consequent immunosuppression intake, regular physician visits and following the recommendations regarding infection prevention. These factors are important to secure a long transplant survival. Especially non-adherence to immunosuppressants is known as a risk factor for transplant rejection. There are several reasons for non-adherent behavior. However identifying the individual motivations is crucial for addressing them correctly. The aim of this article is to give an overview of factors influencing adherence, to introduce options to assess adherence and to present ways to improve adherence. Randomized-controlled intervention studies are presented and on that basis recommendations for clinical practice are derived.

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The TRANSNephro-study examining a new transition model for post-kidney transplant adolescents and an analysis of the present health care: study protocol for a randomized controlled trial

Cited by 42 publications

References 15 publications

Transitional Care and Adherence of Adolescents and Young Adults After Kidney Transplantation in Germany and Austria

Transitional Care and Adherence of Adolescents and Young Adults After Kidney Transplantation in Germany and Austria

Epilepsy: Transition from pediatric to adult care. Recommendations of the Ontario epilepsy implementation task force

Immunsuppressiva-Adhärenz nach Transplantation

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