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Utility and cost of a renal transplant transition clinic

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Abstract

Successful transition from paediatric-centred to adult-oriented healthcare positively influences health outcomes for youth with chronic illness. The primary objective is to evaluate outcomes pre- and post provision of multidisciplinary transition clinic (TC) care to renal transplant recipients. We compared patient and allograft survival in renal transplant recipients at British Columbia Children’s Hospital who received care within a transition clinic (TC) to a cohort of patients transferred prior to establishment of the TC, pre-TC (PTC) in 2007. Baseline characteristics, allograft function, and survival data were collected prospectively via a validated provincial database for 2 years posttransfer. We also estimated and compared the average yearly per-patient cost during the 2-year follow-up period. Thirty-three patients were transferred (PTC) and 12 transitioned (TC). In the PTC cohort, there was a combined poor outcome (death or allograft loss) incidence of 24% within 2 years posttransfer compared with no death or allograft loss in the TC cohort. Cost estimates indicate the average yearly per-patient cost was Canadian dollars (CAD) $17,127–$38,909 for the PTC and CAD $11,380–$34,312 for the TC cohort. For PTC patients who lost their allograft and returned to dialysis, the per-patient cost was CAD $40,956–$61,470. Our results indicate improved allograft and patient survival posttransfer of care in renal transplant recipients who attended TCs, and we found that providing TCs is economically feasible.

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References

  1. American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians–American Society of Internal Medicine (2002) A consensus statement on health care transitions for young adults with special health care needs. Pediatrics 110:1304–1306.

    Google Scholar 

  2. Viner RM (2008) Transition of care from paediatric to adult services: one part of improved health services for adolescents. Arch Dis Child 93:160–163

    Article  PubMed  Google Scholar 

  3. Canadian Paediatric Society (2007) Transition to adult care for youth with special health care needs. Paediatr Child Health 12:785–793.

    Google Scholar 

  4. Kaufman M (2006) Role of adolescent development in the transition process. Prog Transplant 16:286–290

    PubMed  Google Scholar 

  5. Keith DS, Cantarovich M, Paraskevas S, Tchervenkov J (2006) Recipient age and risk of chronic allograft nephropathy in primary deceased donor kidney transplant. Transpl Int 19:649–656

    Article  PubMed  Google Scholar 

  6. Watson AR (2000) Non-compliance and transfer from paediatric to adult transplant unit. Pediatr Nephrol 14:469–472

    Article  PubMed  CAS  Google Scholar 

  7. Magrab P MH, eds (1989) Growing Up and Getting Medical Care: Youth with Special Health Care Needs. Surgeon General’s Conference, Washington, DC: National Center for Networking Community Based Services, Georgetown University Child Development Center.

  8. Bell LE, Bartosh SM, Davis CL, Dobbels F, Al-Uzri A, Lotstein D, Reiss J, Dharnidharka VR (2008) Adolescent Transition to Adult Care in Solid Organ Transplantation: a consensus conference report. Am J Transplant 8:2230–2242

    Article  PubMed  CAS  Google Scholar 

  9. McLaughlin SE, Diener-West M, Indurkhya A, Rubin H, Heckmann R, Boyle MP (2008) Improving transition from pediatric to adult cystic fibrosis care: lessons from a national survey of current practices. Pediatrics 121:e1160–1166

    Article  PubMed  Google Scholar 

  10. Reid GJ, Irvine MJ, McCrindle BW, Sananes R, Ritvo PG, Siu SC, Webb GD (2004) Prevalence and correlates of successful transfer from pediatric to adult health care among a cohort of young adults with complex congenital heart defects. Pediatrics 113:e197–205

    Article  PubMed  Google Scholar 

  11. Cadario F, Prodam F, Bellone S, Trada M, Binotti M, Allochis G, Baldelli R, Esposito S, Bona G, Aimaretti G (2009) Transition process of patients with type 1 diabetes (T1DM) from paediatric to the adult health care service: a hospital-based approach. Clin Endocrinol (Oxf) 71:346–350

    Article  CAS  Google Scholar 

  12. Paone MC, Wigle M, Saewyc E (2006) The ON TRAC model for transitional care of adolescents. Prog Transplant 16:291–302

    PubMed  Google Scholar 

  13. Klarenbach S, Manns B (2009) Economic evaluation of dialysis therapies. Semin Nephrol 29:524–532

    Article  PubMed  Google Scholar 

  14. Levy AR, Sobolev B, James D, Barrable W, Clarke-Richardson P, Sullivan SD, Keown PA, Chung S, Straatman L, Levy RD (2009) The costs of change: direct medical costs of solid organ transplantation in British Columbia, Canada, 1995–2003. Value Health 12:282–292

    Article  PubMed  Google Scholar 

  15. Manns B, Klarenbach S, Lee H, Culleton B, Shrive F, Tonelli M (2007) Economic evaluation of sevelamer in patients with end-stage renal disease. Nephrol Dial Transplant 22:2867–2878

    Article  PubMed  Google Scholar 

  16. Blum RW, Garell D, Hodgman CH, Jorissen TW, Okinow NA, Orr DP, Slap GB (1993) Transition from child-centered to adult health-care systems for adolescents with chronic conditions. A position paper of the Society for Adolescent Medicine J Adolesc Health 14:570–576

    CAS  Google Scholar 

  17. American Academy of Pediatrics Committee on Children with Disabilities and Committee on Adolescence (1996) Transition of care provided for adolescents with special health care needs. Pediatrics 98:1203–1206.

    Google Scholar 

  18. Chaturvedi S, Jones CL, Walker RG, Sawyer SM (2009) The transition of kidney transplant recipients: a work in progress. Pediatr Nephrol 24:1055–1060

    Article  PubMed  Google Scholar 

  19. van den Heuvel ME, van der Lee JH, Cornelissen EA, Bemelman FJ, Hoitsma A, Geskus RB, Bouts AH, Groothoff JW (2010) Transition to the adult nephrologist does not induce acute renal transplant rejection. Nephrol Dial Transplant 25:1662–1667

    Article  PubMed  Google Scholar 

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Acknowledgements

Special thanks to Jamey Shick for assistance with data collection, Ruth Milner for her statistical expertise and guidance, Dr. Douglas Matsell for his critical review of the draft manuscript, and Sema Aydede for cost-estimate literature review.

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No funding source was required for the preparation of this work. The authors have no financial or ethical conflicts of interest as relate to this manuscript.

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Correspondence to Mina Matsuda-Abedini.

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Prestidge, C., Romann, A., Djurdjev, O. et al. Utility and cost of a renal transplant transition clinic. Pediatr Nephrol 27, 295–302 (2012). https://doi.org/10.1007/s00467-011-1980-0

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  • DOI: https://doi.org/10.1007/s00467-011-1980-0

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