Pediatric to adult transition in solid organ transplant recipients: A systematic review of existing transition programs
Shivani Yerigeri1, Matthew Satariano1, Lars Pape2, Jonathan N Johnson3, Stephen D Marks4, Katherine E Twombley5, Kush Doshi6, Jun Oh7, Mignon McCulloch8, Carlos O Esquivel9, Rupesh Raina6,10.
1Northeast Ohio Medical University, Rootstown, OH, United States; 2Department of Pediatrics, University Hospital of Essen, Essen, Germany; 3Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, United States; 4Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; 5Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States; 6Akron Nephrology Associates, Cleveland Clinic Akron General Medical Center, Akron, OH, United States; 7Department of Pediatric Nephrology, University Hamburg-Eppendorf, Hamburg, Germany; 8Department of Paediatrics and Child Health, University of Cape Town, Rondebosch, South Africa; 9Division of Abdominal Transplant, Stanford University School of Medicine, Stanford, CA, United States; 10Department of Pediatric Nephrology, Akron Children’s Hospital, Akron, OH, United States
Background: Pediatric organ transplantation is the primary treatment for end-organ failure. Improving medication adherence and healthcare compliance can decrease healthcare burdens, graft rejection, morbidity, and mortality. Adolescents commonly struggle with non-adherence, necessitating a smooth transition to adult care. This systematic review aims to evaluate existing transition tools and identify their gaps to improve organ recipient outcomes.
Methods: A systematic literature review of studies in electronic databases (PubMed, Google Scholar, and Mendeley) on interventions improving transition in pediatric solid organ transplant recipients (pSOTR) from 2000 to 2022 was conducted. Included studies involved pSOTR before the age of 12 years transitioning to adult care.
Results: A lower proportion of graft acute rejection was observed among pSOTR with more than two transition interventions (10.088%, 95% CI: 0.901% - 27.441%, I2 = 85.95%, p < 0.0001, random effects, five studies, n = 155) compared to those with two or fewer interventions (13.892%, 95% CI: 4.588% - 27.142%, I2 = 74.73%, p = 0.0014, random effects, six studies, n = 140). Additionally, a significant association was found between transition protocols and lower rejection rates (χ² = 10.57, p = 0.0011), with multiple protocols showing better outcomes (χ² = 5.091, p = 0.024). Although adherence scores differed significantly with and without transition protocols (χ² = 8.75, p = 0.0126), no significant difference was found between single and multiple protocol groups (χ² = 4.8, p = 0.091).
Conclusion: This review identifies various transition models and their impact on adherence and graft rejection, which correlate with morbidity and mortality and influence transplant outcomes. The heterogeneity of data within the current literature necessitates further research to establish causality and develop a standardized transition program to improve patient outcomes.
[1] Transition Tools
[2] Transition Program
[3] Solid Organ Transplant
[4] Medication Adherence
[5] Graft Rejection
