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Transplantation. 2011 Jun 27;91(12):1380-5. doi: 10.1097/TP.0b013e31821b2f4b.

Graft failure and adaptation period to adult healthcare centers in pediatric renal transplant patients.

Author information

1
Alberta Children's Hospital, Calgary, Alberta, Canada. s.samuel@albertahealthservices.ca

Abstract

BACKGROUND:

Transfer from pediatric to adult care may require a period of adaptation to the new healthcare environment. We sought to determine whether this adaptation period was associated with an increased risk of graft failure.

METHODS:

Children (age, 0-18 years) recorded in the Canadian Organ Replacement Register who received a first kidney transplant in a pediatric health center between 1992 and 2007, and who had more than or equal to 3 months of graft function, were followed up until death, loss to follow-up, or December 31, 2007. Cox proportional hazards models were used to estimate the excess risk associated with a period of adaptation to adult-oriented care, defined as the interval 0.5 years before to 2.5 years after the first recorded adult care visit. Models were adjusted for age, gender, donor source, and ethnicity.

RESULTS:

Of the 413 patients evaluated, 149 were transferred to adult care during study period. In total, 78 (18.9%) patients experienced graft failure-23 during the adaptation period. Compared with the period before adaptation, the adjusted hazard ratio for graft loss within the adaptation period was 2.24 (95% confidence interval [CI]: 1.19-4.20). The adjusted graft failure rate was 2.26 (1.04-4.93) times higher after 18 years of age than between 0 and 13 years. Aboriginal ethnicity and deceased donor source were also associated with a significantly higher risk of graft failure.

CONCLUSIONS:

The period of adaptation to adult-oriented care is associated with a high risk of graft failure in pediatric renal transplant patients.

PMID:
21519292
DOI:
10.1097/TP.0b013e31821b2f4b
[Indexed for MEDLINE]

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