Pediatric Heart Transplantation: Transitioning to Adult Care (TRANSIT): Baseline Findings

Grady, K. L.; Hof, K. V.; Andrei, A. C.; Shankel, T.; Chinnock, R.; Miyamoto, S.; Ambardekar, A. V.; Anderson, A.; Addonizio, L.; Latif, F.; Lefkowitz, D.; Goldberg, L.; Hollander, S. A.; Pham, M.; Weissberg-Benchell, J.; Cool, N.; Yancy, C.; Pahl, E.

Pediatr Cardiol. 2017 Nov 4; 39(2):354-364

Abstract

Young adult solid organ transplant recipients who transfer from pediatric to adult care experience poor outcomes related to decreased adherence to the medical regimen. Our pilot trial for young adults who had heart transplant (HT) who transfer to adult care tests an intervention focused on increasing HT knowledge, self-management and self-advocacy skills, and enhancing support, as compared to usual care. We report baseline findings between groups regarding (1) patient-level outcomes and (2) components of the intervention. From 3/14 to 9/16, 88 subjects enrolled and randomized to intervention (n = 43) or usual care (n = 45) at six pediatric HT centers. Patient self-report questionnaires and medical records data were collected at baseline, and 3 and 6 months after transfer. For this report, baseline findings (at enrollment and prior to transfer to adult care) were analyzed using Chi-square and t-tests. Level of significance was p < 0.05. Baseline demographics were similar in the intervention and usual care arms: age 21.3 +/- 3.2 vs 21.5 +/- 3.3 years and female 44% vs 49%, respectively. At baseline, there were no differences between intervention and usual care for use of tacrolimus (70 vs 62%); tacrolimus level (mean +/- SD = 6.5 +/- 2.3 ng/ml vs 5.6 +/- 2.3 ng/ml); average of the within patient standard deviation of the baseline mean tacrolimus levels (1.6 vs 1.3); and adherence to the medical regimen [3.6 +/- 0.4 vs 3.5 +/- 0.5 (1 = hardly ever to 4 = all of the time)], respectively. At baseline, both groups had a modest amount of HT knowledge, were learning self-management and self-advocacy, and perceived they were adequately supported. Baseline findings indicate that transitioning HT recipients lack essential knowledge about HT and have incomplete self-management and self-advocacy skills.

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