*Purpose: Inadequate readiness for transition from pediatric to adult care is associated with loss of transplant, initiation of or return to dialysis, and other negative outcomes after transition. Graft failure rate is reported to range from 30% to 35% among renal transplant youth after transition to adult providers. Differences in the patient and family’s goals and expectations and shifts in responsibilities around healthcare behaviors, perception of healthcare provider roles, and health literacy around adult health care systems may all present as risk factors in transition readiness. The purpose of this study is to identify and address barriers to transition preparedness, a crucial part of health care management in pediatric patients from pre- or early teen years in order to set them on a path to successful post-transition care.

*Methods: Participants were 21 post-kidney transplant patients followed at a major pediatric hospital. Mean age at participation was 18.2 years and mean age at transplant was 11.6 years. Patients were administered the STARx Questionnaire, a validated measure of medical transition readiness and the Readiness for Transition to Adult Care Assessment Tool, a survey of transplant-related transition readiness as a part of a multidisciplinary transition program.

*Results: On the STARx Questionnaire, patients reported lowest average scores (1-5 scale) on asking providers about medical care (mean= 3.2) and using internet, books, or other guides to learn more about illness (mean= 2.75). On the Readiness for Transition survey lowest averages (0-2 scale) were observed on knowledge of target medication levels (mean=1.45), make and keep track of appointments (mean= 1.4), and knowledge about health insurance (mean= 1.1). The average score for preparedness for transition was 7.2 (0-10 scale) and for confidence in transition success was 6.9 (0-10 scale).

*Conclusions: Adolescents and young adults in pediatric transplant programs present with a variety of barriers to transition success. It is important to identify patients who are struggling with developmentally appropriate engagement in health care behaviors. Education about illness from providers and external forums, making appointments, and learning about health insurance policies may prepare youths for transition and practicing healthcare skills while under pediatric care may also increase confidence in success after transition. Further research on assessment of readiness and interventions to improve readiness is needed.

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