Hung Ya-Ching, Williams Jonathan E, Bababekov Yanik J, Rickert Chalres G, Chang David C, Yeh Heidi
Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.
Tufts University School of Medicine, Boston, Massachusetts.
Pediatr Transplant. 2019 Nov;23(7):e13547. doi: 10.1111/petr.13547. Epub 2019 Jul 22.
The risk of adverse outcomes for pediatric renal transplant patients is highest during the transition from pediatric to adult care. While there have been many studies focus on graft failure and death, loss to follow-up likely plays a large role in patient outcomes. We hypothesize patients are lost to follow-up during this transition period and that patients transplanted at pediatric centers with a closely affiliated adult center (AFFs) are less likely to suffer from fragmentation of care and become lost to follow-up. AFFs were defined as those pediatric centers whose transplant surgeons were also on staff at an adult center and were identified using center websites. We included patients undergoing renal transplantation at <=18 years of age and had data for the entire transition period on the Scientific Registry of Transplant Recipients (n = 6,762, 92.3% in 95 AFFs). 32% of patients were lost to follow-up. On regression, patients transplanted at AFF were 33% less likely to be lost to follow-up compared with those from non-AFF (OR 0.67 CI 0.54-0.82, P < 0.01). The proportion of patients lost to follow-up during the transition period is remarkably high, but lower among recipients transplanted at AFFs. Poor follow-up may be mitigated by improving integration of care.
小儿肾移植患者不良结局的风险在从儿科护理过渡到成人护理期间最高。虽然有许多研究关注移植失败和死亡，但失访可能在患者结局中起很大作用。我们假设患者在这个过渡期间会失访，并且在与成人中心紧密附属的儿科中心（AFFs）接受移植的患者较少可能遭受护理碎片化并失访。AFFs被定义为那些其移植外科医生也在成人中心任职的儿科中心，并通过中心网站识别。我们纳入了年龄≤18岁且在移植受者科学登记处有整个过渡期间数据的肾移植患者（n = 6762，95个AFFs中占92.3%）。32%的患者失访。经回归分析，与非AFF患者相比，在AFF接受移植的患者失访的可能性降低33%（OR 0.67，CI 0.54 - 0.82，P < 0.01）。过渡期间失访患者的比例非常高，但在AFF接受移植的受者中较低。通过改善护理整合可能减轻随访不佳的情况。
