Improvements in immunosuppression and transplant surgical technique have increased the survival of children with end-stage renal disease. These patients have complex needs, and the current medical system is not prepared to effectively transfer the care of these individuals from pediatric to adult health care systems. Too often transfer of care occurs during moments of crisis and leads to poor outcomes. The long-term goal of this program of research is to enhance care for kidney transplant recipients through higher quality transitions using nurse practitioners as transition leaders. As the foundation for a future nurse intervention study, the major objective of this study is to test the hypothesis that post-transfer (from pediatric to adult services) risk factors for adolescents and young adults who are kidney transplant recipients will have a major impact on health outcomes post-transplant. The primary specific aim of this study is to use a national database, the Scientific Registry of Transplant Recipients (SRTR), to test the hypothesis that the increased risk of graft loss after transfer of care (from pediatric to adult services) for adolescent and young adult kidney transplant recipients over a 3-year post-transfer follow-up period, will be related to post-transfer risk factors (incidence of medication-non compliance, incidence of acute rejection, loss of insurance), when controlling for age, race/ethnicity, length of time since transplant, donor type, and kidney function at time of transfer. Secondary aims of this study are 1) to test the hypothesis that patient risk factors (medication compliance prior to transfer, age, race/ethnicity, insurance status) will predict poor post-transfer medication compliance for youth who are kidney transplant recipients and 2) to describe the incidence of post-transfer risk factors (medication non-compliance, acute rejection, loss of insurance, change in kidney function) during a 3- years post-transfer follow-up period. A retrospective, longitudinal, correlational design using secondary data from the SRTR will be used to evaluate the transfer of care of 1200 kidney transplant recipients (ages 16-25) over a 3-year post-transfer follow-up period. The study will measure the impact of three post-transfer independent variables (risk factors): 1) incidence of medication non-compliance, 2) incidence of acute rejection, and 3) loss of insurance on graft loss after transfer of care. A consecutive sample will be drawn from the SRTR database based on the inclusion/exclusion criteria. Logistic regression will be used to analyze the relationships between graft loss after transfer of care and incidence of medication non-compliance, incidence of acute rejection, and loss of insurance while controlling for identified covariates. Descriptive statistics will be used to summarize sample characteristics and post-transfer risk factors. The results of the study will identify risk factors that nurse transition leaders can target in subsequent studies to improve transition services for youth with a history of a kidney transplant.
