Adolescent and young adult (AYA) kidney transplant (KT) recipients experience high rates of premature allograft loss during healthcare transition (HCT). There is a critical need to identify protective factors associated with stable HCT. Resilience is a learned and dynamic process with known positive impact on health outcomes. This study aims to explore the novel role of resilience as a protective factor in securing stable HCT in AYA with KT.

Participants were AYA with KT transitioning from pediatric to adult nephrology care, and were stratified into stable or unstable HCT groups (unstable= loss-to-follow-up, missed >50% clinic visits in year post-transfer, or unexpected graft loss in year post-transfer). Semi-structured interviews using a reputable resilience model explored the role of key resilience constructs in HCT. Survey and chart review supplied demographic and clinical data.

32 participants enrolled (17 stable; 15 unstable). Key interview themes included: (1) both groups reported knowledge- and skill-based healthcare self-management competencies, (2) both groups endorsed strong connections with adult relatives, (3) the stable group reported more confidence in and more connection to healthcare providers as compared to the unstable group. Significantly more participants in the stable HCT group were white and more of the unstable group was black (p=0.003). A significantly higher percentage of stable participants' parents were college- or graduate school-educated (p=0.011). Adherence (measured by coefficient of variation of immunosuppressant levels) did not differ between groups.

This hypothesis-generating study suggests that in addition to the solid foundation of healthcare self-management competencies often cited as the indicator of HCT readiness, connection with adult relatives as well as interdependence and reliance on one's healthcare team are key constructs of resilience tightly linked to stable HCT among AYA with KT. Importantly, this study suggests that minority and under-resourced AYAs with KT were more likely to have unstable HCT. Further research must explore how to build stronger connections between providers and minority and under-resourced populations across the HCT continuum.

CITATION INFORMATION: Quinn S., Fernandez H., McCorkle T., Barg F., Ginsburg K., Rogers R., Amaral S. The Role of Resilience in Healthcare Transitions among Adolescent and Young Adult Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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