Loss to Follow-up in Adolescent and Young Adult Renal Transplant Recipients

• Type of Material: Article
• Authors: Taylor A Melanson, Emory University; Karie Mersha, oe DiMaggio Children’s Hospital, Hollywood; Rachel Patzer, Emory University; Roshan George, Emory University
• Language: English
• Date: 2021-06-01
• Publisher: Wolters Kluwer Health, Inc
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 Wolters Kluwer Health, Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/TP.0000000000003445
• Title of Journal or Parent Work: Transplantation
• Volume: 105
• Issue: 6
• Start Page: 1326
• End Page: 1336
• Grant/Funding Information: Supported in part by the National Center for Advancing Translational Sciences of the National Institutes of Health under Awards Number UL1TR002378 and TL1TR002382. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The data reported here have been supplied by the Hennepin Healthcare Research Institute (HHRI) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government.
• Keywords: Transition to Adult Care; Retrospective Studies; Young Adult; Age Factors; Adult; Risk Assessment; Time Factors; Risk Factors; Adolescent; Treatment Outcome; Kidney Transplantation; Child; Male; Lost to Follow-Up; Humans; Registries; Female; Quality Indicators, Health Care

Abstract

BACKGROUND: Patients' loss to follow-up (LFU) has significant impacts on outcomes and is a barrier to improving care, especially in adolescent and young adult (AYA) renal transplant recipients. There is limited information regarding the relationship between transfer of care from pediatric to adult transplant centers, age, and LFU among AYA renal transplant recipients. METHODS: We studied 16 386 individuals aged 10-29 years who received kidney transplants between January 1, 2005 and December 31, 2015 using the Scientific Registry of Transplant Recipients. The primary outcome was LFU, which was defined as >1 year without follow-up in a transplant clinic/program. Death or graft failure within a year of the last follow-up was not classified as LFU. We performed a retrospective cohort study describing LFU using Pearson's chi-square tests. Multivariable logistic regression was used to estimate the change in likelihood of LFU associated with recipient characteristics and institution transfer. RESULTS: In total, 22.26% (n = 3647) of our study population met criteria for LFU. About 11.17% (n = 1830) transferred institutions during the study period. LFU occurred in 50.18% of recipients who transferred institutions. LFU peaked at the age of 20 years, with 7.4% of 20-year-olds having LFU. The odds of LFU among renal transplant recipients who transferred institutions were 3.36 times greater (95% confidence interval, 3.1-3.6) than the odds of LFU among those who did not transfer institutions. CONCLUSIONS: LFU is a critical problem faced by AYA renal transplant recipients, and institution transfer is a significant risk factor for LFU. Additional studies investigating the interplay between age, institution transfer, and LFU in the AYA population are still needed.