Y. Hung1,2, Y. J. Bababekov1,2, C. G. Rickert1,2, J. E. Williams1,3, D. C. Chang1,2, H. Yeh1,2 1Massachusetts General Hospital,Surgery,Boston, MA, USA 2Harvard School Of Medicine,Brookline, MA, USA 3Tufts Medical Center,Boston, MA, USA
Introduction: The risk of adverse outcomes for pediatric renal transplant patients is highest during the transition period (TP) from pediatric to adult care, attributed in part to non-compliance. While the majority of the studies focus on graft failure and death, loss to follow-up likely plays a large role in both compliance and survival. We hypothesized that many pediatric patients are lost to follow-up during the ages 16-22 and that patients transplanted at pediatric centers with a closely affiliated adult center (AFFs) were less likely to suffer from fragmentation of care and loss to follow-up.
Methods: Patients undergoing renal transplantation at <18 years of age who had data for the entire TP, defined as age 16 to 22, were included. Main outcome was loss to follow-up during the TP after excluding patients who died or lost their grafts. AFFs were defined as those pediatric centers whose transplant surgeons were also on staff at an adult center and were identified using transplant center websites. Logistic regression was performed, adjusting for patient and system factors on the Scientific Registry of Transplant Recipients 1979-2017.
Results: 6,762 patients were included, with 92.3% of them (n=6,243) transplanted at 95 AFF. Overall graft failure and death rates were 13.6% and 5.2%, respectively (14.1% and 5.2% at non-AFF vs 13.6% and 5.1% at AFF, p>0.05). However, the overall loss to follow-up rate was 32% and varied significantly between non-AFF and AFF (38.3% vs 31.4%, p<0.01). On adjusted analysis, patients transplanted at non-AFF were 50% more likely to be lost to follow-up compared to those from AFF (OR 1.5, p<0.01). In addition, patients with Medicaid or Medicare had higher risks of loss to follow-up than patients with private insurance (OR 1.3, OR 1.5, respectively. All p<0.05) (Table 1).
Conclusion: The risk of loss to follow-up during the TP is alarmingly high, and is significantly higher among recipients transplanted at non-AFFs. Graft and patient survival among patients lost to follow-up are likely quite low and the reported graft and patient survival for the transition period are likely overestimated. Poor follow-up may be mitigated by improving the integration of care when transferring patients from pediatric to adult transplant centers.
