*Purpose: Introduction: Adolescent and young adult (AYA) recipients of renal transplants (RTR) are confronted with a unique set of stressors. Rates of non-adherence are high (estimated between 30-70%). Transition (T) from pediatric to adult provider teams during this life period has the potential for intensifying risk at an already high-risk time. Our center implemented a comprehensive multidisciplinary transition program (CMTP) in 2016. We hypothesized that completion of the CMTP would improve outcomes for our AYA RTRs transitioning to adult care.

*Methods: We studied 22 AYA RTRs. 10 AYA RTRs completed our CMTP, which consisted of longitudinal preparation for T, as well as a day-long seminar for AYAs and families including transplant social work, psychology, adult nephrology, and pharmacy modules. 12 AYA RTRs transitioned to adult care without completion of CMTP. Graft and patient outcomes were assessed longitudinally over 1 year following T.

*Results: Rejection (biopsy proven, antibody and/or cell-mediated) was less common in the CMTP group (p: 0.009), as was prevalence of de novo DSA (Class 1 and/or Class 2) formation (p: 0.009) during the 1-year follow-up period after T. Two patients experienced graft loss after T; neither participated in CMTP. Mean tacrolimus troughs were similar in CMTP versus non-CMTP groups 1 year after T (7.53ng/mL (SD: 1.8) vs. 7.03ng/mL (SD: 2.0), p: 0.56, respectively)). Variance of tacrolimus was also similar between groups (2.02 (SD: 1.7) vs. 2.27 (SD: 2.1), p: 0.79). Mean time to first appointment between pediatric and adult providers was shorter for the CMTP group, though not significant (106 (SD: 59) days vs. 132 (SD: 144) days). There was no difference in prevalence of CMV, EBV or BK viremias between groups.

*Conclusions: Implementation of longitudinal CMTP has the potential to positively impact graft and patient outcomes in an AYA and thus high-risk RTR population. This positive impact may be realized by the CMTP itself. Alternatively, patients more likely to have better outcomes as evidenced by having better GFRs, less exposure to sirolimus and prednisone, less DSAs and less rejection, may also just be more likely to participate in a CMTP. Larger studies would be needed to clarify this and optimize T for RTRs further.

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