Transitional Care and Adherence of Adolescents and Young Adults After Kidney Transplantation in Germany and Austria A Binational Observatory Census Within the TRANSNephro Trial

被引：38

作者：

Kreuzer, Martin ^{[1
,2
]}

Pruefe, Jenny ^{[1
]}

Oldhafer, Martina ^{[2
]}

Bethe, Dirk ^{[3
]}

Dierks, Marie-Luise ^{[4
]}

Muether, Silvia ^{[2
,5
]}

Thumfart, Julia ^{[6
]}

Hoppe, Bernd ^{[7
]}

Buescher, Anja ^{[8
]}

Rascher, Wolfgang ^{[9
]}

Hansen, Matthias ^{[10
]}

Pohl, Martin ^{[11
]}

Kemper, Markus J. ^{[12
]}

Drube, Jens ^{[1
]}

Rieger, Susanne ^{[3
]}

John, Ulrike ^{[13
]}

Taylan, Christina ^{[14
]}

Dittrich, Katalin ^{[15
]}

Hollenbach, Sabine ^{[16
]}

Klaus, Guenter ^{[17
]}

Fehrenbach, Henry ^{[18
]}

Kranz, Birgitta ^{[19
]}

Montoya, Carmen ^{[20
]}

Lange-Sperandio, Baerbel ^{[21
]}

Ruckenbrodt, Bettina ^{[22
]}

Billing, Heiko ^{[23
]}

Staude, Hagen ^{[24
]}

Heindl-Rusai, Krisztina ^{[25
]}

Brunkhorst, Reinhard ^{[26
]}

Pape, Lars ^{[1
,2
]}

机构：

[1] Hannover Med Sch, Dept Pediat Kidney Liver & Metab Dis, Carl Neuberg Str 1, D-30625 Hannover, Germany

[2] German Soc Transit Med, Hannover, Germany

[3] Univ Heidelberg Hosp, Ctr Child & Adolescent Med, Div Pediat Nephrol, Heidelberg, Germany

[4] Hannover Med Sch, Dept Epidemiol Social Med & Hlth Syst Res, D-30625 Hannover, Germany

[5] DRK Kliniken German Red Cross Hosp Berlin, Berliner Transit Programm, Berlin, Germany

[6] Charite, Dept Pediat Nephrol, Berlin, Germany

[7] Univ Hosp Bonn, Bonn, Germany

[8] Essen Univ Hosp, Dept Pediat 2, Essen, Germany

[9] Univ Erlangen Nurnberg, Childrens Hosp, Erlangen, Germany

[10] Clementine Childrens Hosp, KfH Ctr Pediat Nephrol, Frankfurt, Germany

[11] Freiburg Univ Hosp, Dept Gen Pediat Adolescent Med & Neonatol, Freiburg, Germany

[12] Univ Childrens Hosp Eppendorf, Hamburg, Germany

[13] Univ Childrens Hosp, Jena, Germany

[14] Univ Hosp Cologne, Pediat Nephrol, Cologne, Germany

[15] Univ Childrens Hosp, Leipzig, Germany

[16] St Georg Hosp, KfH Ctr Pediat Nephrol, Leipzig, Germany

[17] Univ Hosp Marburg, KfH Ctr Pediat Nephrol, Marburg, Germany

[18] Childrens Hosp Memmingen, KfH Ctr Pediat Nephrol, Memmingen, Germany

[19] Univ Childrens Hosp Munster, Munich, Germany

[20] Univ Childrens Hosp Munchen Schwabing, KfH Ctr Pediat Nephrol, Munich, Germany

[21] Univ Munich, Dr von Haunersches Kinderspital, Munich, Germany

[22] Olgahosp Klinikum Stuttgart, Childrens Hosp, Stuttgart, Germany

[23] Univ Childrens Hosp Tubingen, Tubingen, Germany

[24] Univ Childrens Hosp, Rostock, Germany

[25] Univ Childrens Hosp, Vienna, Austria

[26] Hosp Hannover Reg, KfH Ctr Nephrol, Hannover, Germany

来源：

MEDICINE | 2015年 / 94卷 / 48期

关键词：

GRAFT FAILURE; HEALTH-CARE; MEDICATION ADHERENCE; BLOOD-LEVELS; REGIMEN; RISK; NONCOMPLIANCE; NONADHERENCE; VARIABILITY; PREVALENCE;

D O I：

10.1097/MD.0000000000002196

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 132mol/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 0.200.1. 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.

引用

页数：8

共 31 条

[1] Medication adherence in the transition of adolescent kidney transplant recipients to the adult care [J].

Akchurin, Oleh M. ;

Melamed, Michal L. ;

Hashim, Becky L. ;

Kaskel, Frederick J. ;

Del Rio, Marcela .

PEDIATRIC TRANSPLANTATION, 2014, 18 (05) :538-548

[2]

Blum RW, 2002, PEDIATRICS, V110, P1304

[3] Meta-Analysis of Medical Regimen Adherence Outcomes in Pediatric Solid Organ Transplantation [J].

Dew, Mary Amanda ;

Dabbs, Annette DeVito ;

Myaskovsky, Larissa ;

Shyu, Susan ;

Shellmer, Diana A. ;

DiMartini, Andrea F. ;

Steel, Jennifer ;

Unruh, Mark ;

Switzer, Galen E. ;

Shapiro, Ron ;

Greenhouse, Joel B. .

TRANSPLANTATION, 2009, 88 (05) :736-746

[4] Adherence to the immunosuppressive regimen in pediatric kidney transplant recipients: A systematic review [J].

Dobbels, F. ;

Ruppar, T. ;

De Geest, S. ;

Decorte, A. ;

Van Damme-Lombaerts, R. ;

Fine, R. N. .

PEDIATRIC TRANSPLANTATION, 2010, 14 (05) :603-613

[5] Heightened graft failure risk during emerging adulthood and transition to adult care [J].

Foster, Bethany J. .

PEDIATRIC NEPHROLOGY, 2015, 30 (04) :567-576

[6] Association Between Age and Graft Failure Rates in Young Kidney Transplant Recipients [J].

Foster, Bethany J. ;

Dahhou, Mourad ;

Zhang, Xun ;

Platt, Robert W. ;

Samuel, Susan M. ;

Hanley, James A. .

TRANSPLANTATION, 2011, 92 (11) :1237-1243

[7]

Frei U, 2008, NIERENERSATZTHERAPIE

[8] Impact of computer-based patient education on illness-specific knowledge and renal function in adolescents after renal transplantation [J].

Freier, Christina ;

Oldhafer, Martina ;

Offner, Gisela ;

Dorfman, Suzanne ;

Kugler, Christiane .

PEDIATRIC TRANSPLANTATION, 2010, 14 (05) :596-602

[9] Banff 2013 update: Pearls and pitfalls in transplant renal pathology [J].

Hara, Shigeo .

NEPHROLOGY, 2015, 20 :2-8

[10] Bridging the gap: an integrated paediatric to adult clinical service for young adults with kidney failure [J].

Harden, P. N. ;

Walsh, G. ;

Bandler, N. ;

Bradley, S. ;

Lonsdale, D. ;

Taylor, J. ;

Marks, S. D. .

BMJ-BRITISH MEDICAL JOURNAL, 2012, 344

← 1 2 3 4 →