Purpose: A structured shift in allocation of responsibility (AoR) for health-management tasks from parents to adolescents is an important component of the transfer to adult-based care. The purpose of this study was to assess the relationship between AoR pre-transfer and medication adherence post-transfer among pediatric liver transplant recipients.

Methods: Patients' self-reported responsibility for their care at the time of their last visit in the pediatric liver transplant clinic was assessed using a previously-described measure of AoR. Average scores were calculated for two components of AoR – communication skills and self-management skills – on a 3-point scale with higher numbers indicating increased patient responsibility. Data regarding adherence and outcomes for the year following transfer was collected from the medical record. Time of transfer was defined as the first visit in the adult clinic. Tacrolimus standard deviation (tacro SD) in the year post-transfer was used as a surrogate marker for medication adherence, with nonadherence defined as SD > 2. The study population was analyzed using descriptive statistics, and Spearman's rank correlation coefficients (rho) were used to assess the association between AoR and tacro SD.

Results: From June 2010 through December 2015, 26 patients completed the AoR measure and subsequently transferred to the adult liver transplant clinic, and 17 were > 1 year from transfer. The median age at the time of transplant was 9y and at the time of transfer was 21.4y. Median tacro SD among the 17 patients > 1 year post-transfer was 1.2. No patients had biopsy-proven rejection in the first year post-transfer. Median AoR for communications tasks was 2.9 and for self-management 3. There was not a statistically significant relationship in this sample between tacro SD and AoR for communication (rho=.291, p=.293) or self-management (rho=-.102, p=.717) tasks.

Conclusions: While there was not a significant relationship between pre-transfer AoR and post-transfer medication adherence, the median tacro SD and AoR values suggest an overall adherent patient population who perceived themselves to be primarily responsible for managing their care by the time of transfer. The high rates of adherence and positive health outcomes in this sample, together with the older age at transfer, emphasize the importance of an individualized transition process that is focused on communication and self-management rather than relying on age alone.

CITATION INFORMATION: Bilhartz J, Lopez M, Magee J, Shieck V, Eder S, Fredericks E. Factors in a Successful Transfer of Pediatric Liver Transplant Recipients to Adult-Based Care. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress