Transitional care models in adolescent kidney transplant recipients—a systematic review

Abstract

Objective Adolescence is a time of significant change for patients, guardians, and clinicians. The Paediatrician must ensure patients develop the necessary skills and knowledge required to transition and to function as an independent entity, with autonomy over their own care. The transfer from paediatric to adult care carries an increased risk of graft-related complications attributable to a multitude of reasons, particularly non-adherence to immunosuppressant medicines and poor attendance at scheduled appointments. This systematic review was conducted to ascertain the transitional care models available to clinicians caring for kidney transplant recipients and to compare the approach in each respective case. Method A systematic review was performed, in a methodology outlined by the PRISMA guidelines. MEDLINE Ovid & EMBASE databases were searched for studies that outlined valid, replicable models pertaining to transitional care of paediatric kidney transplant recipients between 1946 and Q3-2021. The reference lists of selected articles were also perused for further eligible studies and experts in the field for further eligible articles. Two investigators assessed all studies for eligibility and independently performed data extraction, any discrepancies were settled by consensus. Results A total of 1,121 abstracts were identified, which was reduced to 1,029 upon removal of duplicates. A total of 51 articles were deemed appropriate for full-text review and critical appraisal. Twelve articles which described models for transition pertaining to kidney transplant patients were included in qualitative synthesis. Every paper utilised a different transition model. All but one model included a physician and nurse at minimum in the transition process. The involvement of adult nephrologist medical social work, psychology and psychiatry was variable. The mean age for initiation of transition was 13.4 years range: 10-17.5 years. The mean age at transfer to adult services was 18.3 years range: 16-20.5 years. Conclusion Despite the well-established need for good transitional care in paediatric solid-organ transplant recipients, models tailored specifically for kidney transplant recipients are lacking. Further research and validation studies are required, to ascertain the most best method of providing effective transitional care to these patients. Transitional care should become a standardised process for adolescents and young adults with a kidney transplant.

A scoping review of pediatric transplant education

“…We only reviewed literature that was published in English and as such we may have missed studies published in other languages. We excluded studies that pertained to pediatric to adult transition programs and clinics, since this topic has been previously reviewed, 17–19 and our objective was to focus specifically on pediatric education. However, in doing so, we may have inadvertently missed an educational program aimed at the pediatric population.…”

“…We decided a priori that we would review publications that included both adult and pediatric centers, if the outcomes described in the article specifically distinguished between pediatric and adult findings. We excluded studies which pertained to the transition from pediatric to adult transplant care, since this topic has been previously reviewed elsewhere 17‐19 …”

“…We excluded studies which pertained to the transition from pediatric to adult transplant care, since this topic has been previously reviewed elsewhere. [17][18][19]…”

“…15,16 In addition to educating children and youth about fundamental transplant concepts, the education should be presented in a way that is relatable and covers the unique context of a pediatric patient. Literature reviews have described transplant education and models related to the transition of care from pediatric to adult programs [17][18][19] and non-pharmacologic transplant interventions aimed at caregivers. 20 None, however, have specifically summarized educational interventions in pediatric transplantation.…”

Medication adherence in pediatric kidney transplantation: How to build a bridge over troubled water

“…Apart from this observation, there seems to be no consensus on what is the best transitional care model. 44 Hence, further research is needed to design and implement a formal transition model for pediatric kidney transplantation specifically, tapping into available generic transition models, such as the "Ready Steady Go Model" or existing consensus recommendations, such as those of the International Pediatric Nephrology Association. 45,46 The most inspirational work, however, comes from the group of Varnell and colleagues.…”