The transition of kidney transplant recipients: a work in progress

This study examined the process of transition for pediatric kidney transplant recipients who were transferred from the Royal Children’s Hospital to adult health services between October 2005 and September 2006. A retrospective review of case notes was used to identify graft stability 12 months before and after transfer. A patient satisfaction questionnaire was sent to all transferred patients in October 2007. Eleven patients were identified with a mean age of 19.5 years. Nine of these 11 patients remained medically stable over the 2-year study period, as evident by stable serum creatinine estimations pre- and post-transfer and no episodes of rejection or hospital admissions. One patient had advanced chronic allograft nephropathy at the time of transfer and, as anticipated, required dialysis 12 months thereafter. Another patient experienced antibody-mediated rejection soon after transfer and required intensive therapy. Ten subjects (91%) completed the satisfaction questionnaire. The responses suggested inadequate involvement of young people in the transition planning and the perception of a lack of preparation prior to transfer to adult services. Overall, the results indicate that transition planning needs to start earlier and should involve young people more actively and that the focus should be broadened beyond achieving transfer, as may currently be the case, to more fully reflect what is embodied by the term transition.