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 is associated with poor outcomes. The aim of this study was 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 2-3 year post-transfer follow-up period, was related to post-transfer risk factors (medication non-compliance, acute rejection, insurance status, serum creatinine at transfer). A retrospective, longitudinal, correlational design using secondary data and logistic regression was used to evaluate the transfer of care of 250 kidney transplant recipients (ages 16-25) over a 2-3-year post-transfer follow-up period. 77 (30.8%) individuals lost their graft within 2-3 years after transfer of care. Medication non-compliance (NC), acute rejection (AR), and creatinine at transfer (Scr) were significant independent predictors of graft loss after transfer of care. NC increased the odds of graft loss after transfer of care by 8.5 times, AR increased the odds of graft loss after transfer of care by 10.8 times, and having a Scr > 2.0 mg/dl at the time of transfer increased the odds of graft loss after transfer of care by 5.5 times. These results identify individuals who are at risk for graft loss after transfer of care and who may benefit from increased support during this risky period.

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