The Department of Paediatric Nephrology & Transplantation, Children's Health Ireland at Temple St, Dublin, Ireland.
The Department of Paediatric Nephrology, Children's Health Ireland at Crumlin, Dublin, Ireland.
Nephrol Dial Transplant. 2023 Jan 23;38(1):49-55. doi: 10.1093/ndt/gfac175.
Adolescence is a time of significant change for patients, guardians and clinicians. The paediatrician must ensure patients develop the necessary skills and knowledge required to transition and to function as an independent entity, with autonomy over their own care. The transfer from paediatric to adult care carries an increased risk of graft-related complications attributable to a multitude of reasons, particularly non-adherence to immunosuppressive medicines and poor attendance at scheduled appointments. This systematic review was conducted to ascertain the transitional care models available to clinicians caring for kidney transplant recipients and to compare the approach in each respective case.
A systematic review was performed, in a methodology outlined by the PRISMA guidelines. OVID MEDLINE and EMBASE databases were searched for studies that outlined valid, replicable models pertaining to transitional care of paediatric kidney transplant recipients between 1946 and Quarter 3 of 2021. The reference lists of selected articles were also perused for further eligible studies and experts in the field were consulted for further eligible articles. Two investigators assessed all studies for eligibility and independently performed data extraction. Any discrepancies were settled by consensus.
A total of 1121 abstracts were identified, which was reduced to 1029 upon removal of duplicates. A total of 51 articles were deemed appropriate for full-text review and critical appraisal. A total of 12 articles that described models for transition pertaining to kidney transplant patients were included in qualitative synthesis. Every paper utilized a different transition model. All but one model included a physician and nurse at minimum in the transition process. The involvement of adult nephrologists, medical social work, psychology and psychiatry was variable. The mean age for the initiation of transition was 13.4 years (range: 10-17.5 years). The mean age at transfer to adult services was 18.3 years (range: 16-20.5 years).
Despite the well-established need for good transitional care for paediatric solid-organ transplant recipients, models tailored specifically for kidney transplant recipients are lacking. Further research and validation studies are required to ascertain the best method of providing effective transitional care to these patients. Transitional care should become a standardized process for adolescents and young adults with kidney transplants.
青少年时期是患者、监护人及临床医生发生重大变化的时期。儿科医生必须确保患者具备过渡和独立管理自身护理所需的必要技能和知识。从儿科护理转为成人护理会增加与移植物相关的并发症风险，这归因于多种原因，特别是免疫抑制药物不依从和未按时预约就诊。本系统评价旨在确定可供照顾肾移植受者的临床医生使用的过渡护理模式，并比较每种情况下的方法。
按照 PRISMA 指南概述的方法进行系统评价。在 OVID MEDLINE 和 EMBASE 数据库中检索了 1946 年至 2021 年第 3 季度期间有关儿科肾移植受者过渡护理的有效、可复制模式的研究。还查阅了选定文章的参考文献列表，以获取更多合格研究，并咨询了该领域的专家以获取更多合格文章。两名调查员评估了所有研究的合格性，并独立进行了数据提取。任何分歧均通过协商解决。
共确定了 1121 篇摘要，删除重复项后减少至 1029 篇。共有 51 篇文章被认为适合全文审查和批判性评估。共有 12 篇描述与肾移植患者过渡相关的模型的文章被纳入定性综合分析。每篇论文都使用了不同的过渡模型。除了一个模型外，所有模型在过渡过程中都至少有一名医生和护士。成人肾病专家、医学社会工作者、心理学和精神病学的参与情况各不相同。开始过渡的平均年龄为 13.4 岁（范围：10-17.5 岁）。转至成人服务的平均年龄为 18.3 岁（范围：16-20.5 岁）。
尽管已经明确需要对儿科实体器官移植受者进行良好的过渡护理，但缺乏专门针对肾移植受者的模式。需要进一步研究和验证研究，以确定为这些患者提供有效过渡护理的最佳方法。过渡护理应成为有肾脏移植的青少年和年轻人的标准化流程。
