*Purpose: Transition of transplant recipients from youth to adult care has been a challenge for many. Starting in March 2017, Lucile Packard Children’s Hospital (LPCH) instituted a transplant transition program starting at age 12. Here we present the outcomes (graft loss, loss to follow-up, and mortality) in the patients transitioned from 03/2017 to 11/2019 (32 months since), compared to 07/2014 to 03/2017 (32 months prior).

*Methods: We approach transition in 3 stages, ages 12-18, 18-21+ and the transition period. Each stage involves age-specific methods to encourage autonomy, parental interventions, and a multi-disciplinary approach to their transplant care. We looked at patients transitioned in the past 5+ years with our formalized transition process. Our primary outcomes were mortality, loss to follow-up (defined as failure to attend a second appointment), and graft loss. We divided patients into those transitioned to Stanford Health Care (SHC) vs outside institutions.

*Results: We transitioned 120 patients from 07/2014 to 11/2019. 43 patients transitioned in the 32 months prior to instituting our transition program and 76 transitioned in the 32 months since.

Of the 43 patients, 2 (4.7%) were lost to follow-up and 8 (19%) returned to dialysis before transition could be completed. 11 patients (26%) transitioned to SHC, 7 (16%) transitioned to Kaiser/UCSF, and 15 (35%) transitioned to other institutions. After transition, 1 SHC patient was re-transplanted and 1 returned to HD. Remaining 9 patients (82%) are following up regularly with a SHC Nephrologist. Of the 76 patients in the 32 months after starting our program, 4 started dialysis prior to completion of transition, 3 were lost to follow up and 1 died. 36 (47%) were transitioned to SHC, 12 (16%) to Kaiser/UCSF, and 20 (26%) were transitioned to other institutions. Of the SHC patients who transitioned, 1 patient died, 1 returned to dialysis and 2 were lost to follow-up. The remaining 32 (89%) patients have maintained regular follow-up. Data from other institutions is incomplete.

*Conclusions: LPCH transplants 30-50 patients per year. We have a panel of 236 patients, some of whom we have managed for more than 20 years. We have transitioned 120 of these patients in the past 5 years. Since instituting our transition practice 3 years ago, we have transferred almost twice the number of patients in the same amount of time but have been able to preserve low rates of graft loss, mortality and loss to follow-up. Our program focuses on not only patient skills, but also striking a fine balance between parental guidance and autonomy. For the patients that transition to SHC, we are also able to help compliance by using a team approach that understands the unique challenges our young adult population faces. A structured transition program involving a dedicated team is crucial for the successful transition of transplanted youth from pediatric to adult programs.

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