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Transitoining in kidney tx final version2
This document discusses the transition of pediatric renal transplant recipients to adult care. It notes that while pediatric patients are different and pediatric hospitals are not meant for adults, patients must eventually transition to adult services. However, an unplanned transition can be problematic. The document recommends a phased transition process beginning in the teen years that addresses medical, psychosocial and educational needs through a dedicated transition clinic involving both pediatric and adult teams to ensure continuous care and support during the vulnerable transition period.
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Transitoining in kidney tx final version2
- 1. Transition of PediatricRenal Transplant Recipients Mind the Gap Pediatric Renal Transplantation Unit, Cairo University Prof. Fatina Fadel Prof. Hafez Bazaraa
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- 3. BACKGROUND < » Pediatric patientsare different » A dedicated pediatric program is important » Pediatric transplantation program based in pediatric hospitals (Cairo University 2009-2019) » Adult nephrology is a separate facility
- 4. Transition: Why? » Patientsgrow » Pediatric hospitals & pediatricians are not meant to care for adults » Adults cannot be admitted/ subjected to procedures at pediatric hospitals » We cannot follow patients and then refer them elsewhere when they need admission or intervention
- 5. Transition: Why? Our patientsmust eventually go to adult service
- 6. Transition: When? » Hospitaladmission rule: 13yrs » No distinct adolescent care units » Legal adulthood 18-21 yrs
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- 8. Transition: Why NOT? »Patient, parent & care-provider comfort zone » Many are stable; no specific needs » Unwillingness to receive patients with an extensive background elsewhere » Difference in independency vs support between adult/ Ped. Units » Difference in medication financing/ insurance change
- 13. Transition: Why NOT? »The result is often an unplanned, possibly problematic, transition » Adding to an already high-risk adolescent period
- 17. Van Arendonk KJ,et al, CJASN February 2013, 8: 1–8 Age at Graft Loss after Pediatric Kd Tx: Exploring the High-Risk Age Window
- 18. Van Arendonk KJ,et al, CJASN February 2013, 8: 1–8 Age at Graft Loss after Pediatric Kd Tx: Exploring the High-Risk Age Window
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- 22. Watson AR, BRITISHJOURNAL OF RENAL MEDICINE 2011; 16 (1): 15 - 18
- 23. Fredericks EM andLopez MJ, Clinical Liver Disease, 2013. 2, (5): 223-226 Transfer changes in health care providers, clinic locations, or both Transition active process that addresses the medical, psychosocial, and educational/vocational needs of adolescents as they prepare to move from child-centered health care to adult- centered health care
- 25. Transition: HOW? » Transitionclinic at pediatric unit » Patients allocated for transition based on age & condition by pediatric team » Clinic attended by members of both teams » Admission/ procedures mostly at adult unit through transition clinic » Transition process through clinic with transfer to adult clinic when complete
- 26. Transition process » Early(pre) transition 14-18y » Active (actual) transition 18-21y Transfer completed » Post-transition follow-up
- 29. Transition: ISSUES? » Backlogof older adolescent patients with tendency to a rushed transition » Patient/ parent non-familiarity with adult services & procedures » Insurance policy changes » Medical conditions requiring active management
- 31. Watson AR, BRITISHJOURNAL OF RENAL MEDICINE 2011; 16 (1): 15 - 18
- 34. Raina R, etal, Ann Transplant, 2018; 23: 45-60 Identified 4 competency areas to educate patient prior to transition
- 35. Adolescent Transition toAdult Care in Solid Organ Transplantation: A consensus conference report Bell LE, et al, American Journal of Transplantation 2008; 8: 2230–2242
- 36. Raina R, etal, Ann Transplant, 2018; 23: 45-60
- 38. Raina R, etal, Ann Transplant, 2018; 23: 45-60
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- 40. Transition: Recommendations » Reviewing condition& care plan before transition » Phased transition based on age, time & progress
- 41. Transition: Recommendations » Reviewing condition& care plan before transition » Phased transition based on age, time & progress – Start early – Patient awareness & responsibility – Phased autonomy – Uniformity/ Awareness of adult service – Defined effective channels of problem identification/ management
- 42. Transition: Recommendations » Reviewing condition& care plan before transition » Phased transition based on age, time & progress » Appropriate commitment from transition team. Patients need MORE CARE during transition. » Adolescent clinics/ in-patient units » Ensuring continuous support; medical, social & financial » Transfer is the outcome of transition » Post-transition follow-up