Coordinated, Multimodal Care After Kidney Transplantation Improves Graft Survival and Cardiovascular Risks – Results of the Kidney Transplantation 360°- Study (ktx360°)
L. Pape1, M. DeZwaan2, V. Kliem3, H. Nolting4, J. Wolff4, U. Tegtbur5, M. Schiffer6
1Pediatrics II, University Hospital of Essen, Essen, Germany, 2Pediatrics II, Hannover Medical School, Hannover, Germany, 3Nephrologic Center Hannoversch Münden, Hannoversch Münden, Germany, 4IGES Insititue, Berlin, Germany, 5Hannover Medical School, Hannover, Germany, 6University Hospital of Erlangen, Erlangen, Germany
Meeting: 2022 American Transplant Congress
Abstract number: 759
Keywords: Economics, Graft survival, Outpatients, Psychiatric comorbidity
Topic: Clinical Science » Kidney » 35 - Kidney: Cardiovascular and Metabolic Complications
Session Information
Session Name: Kidney: Cardiovascular and Metabolic Complications
Session Type: Poster Abstract
Date: Saturday, June 4, 2022
Session Time: 5:30pm-7:00pm
Presentation Time: 5:30pm-7:00pm
Location: Hynes Halls C & D
*Purpose: Cardiovascular events and reduced graft survival due to non-adherence are the most important reasons for morbidity and mortality after KTx. Outpatient care in Germany is split between transplant centers and nephrology practices which is often not perfectly coordinated and uses 20th century rather than digital communication.
*Methods: The new aftercare program for pediatric and adult KTx patients was implemented comprising a central coordination of patient visits, case-management, electronic case files, telemedicine, risk-assessment based interventions for non-adherence by psychosomatic counselling and of cardiovascular risks by individualized physical training. The study used a quasi-experimental design with two data sources: primary data collected among study participants and secondary data, i. e., claims data from health insurance companies. In primary data longitudinal changes were studied. In claims data changes from a control period (before 2017) to the intervention period (after 2017) were compared between the ITT-group (intervention centers) and the control group (other centers).
*Results: 937 adult (mean age 52±14 years, 41% f, 28% LD) and 72 pediatric patients (mean age 11±45 years, 46% f, 30% LD) were included in 3 German centers. The external control cohort consisted of 2565, the internal and external historic control cohorts of 269 and 3028 patients. Graft loss was significantly lower in the intervention group as compared to the external cohort (6% vs. 9%, p=0.08). In adults, adherence to aftercare visits was significantly higher in the intervention group as compared to external controls (93% vs. 56%, p<0.001). Adherence to immunosuppressants increased significantly over time (b=0.06, p=0.006), Hospitalization due to cardiovascular events was significantly lower in the KTx360° patients compared to the external cohort (7 vs. 17%, p<0.001). The case management was used by 99% of the patients. General SOPs were developed and implemented. A reduction of hospitalizations and health care costs could not yet be reached during the study period.
*Conclusions: The multimodal and multidisciplinary KTx360°-program significantly improved the clinical course after KTx. Main achievements were improved graft survival, increase of adherence, and reduction of cardiovascular risks. It can be speculated that these effects will also lead to an improvement in long-term patient and graft survival. A health care cost reduction could not be shown during the study period; however, longer-term follow-up is warranted to better investigate the effect on care costs.
To cite this abstract in AMA style:
Pape L, DeZwaan M, Kliem V, Nolting H, Wolff J, Tegtbur U, Schiffer M. Coordinated, Multimodal Care After Kidney Transplantation Improves Graft Survival and Cardiovascular Risks – Results of the Kidney Transplantation 360°- Study (ktx360°) [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/coordinated-multimodal-care-after-kidney-transplantation-improves-graft-survival-and-cardiovascular-risks-results-of-the-kidney-transplantation-360-study-ktx360/. Accessed December 12, 2024.« Back to 2022 American Transplant Congress