Implementation of a Transition Process for Pediatric Kidney and Liver Transplant Patients

Background: Solid organ transplant is a standard of care for pediatric patients with end
stage organ disease. The period of transition from pediatric to adult care poses a
significant threat, with liver transplant studies reporting 28% mortality within 2 years of
transfer and kidney transplant research reporting 30% within 3 years. In an effort to
prepare pediatric transplant recipients for transition to an adult centered program, we
implemented an Evidence Based Practice initiative at an academic medical center in
central Virginia. The long term goal of this practice chance is to reduce the morbidity
and mortality associated with that transition period.
Methods: Transplant recipients age 17 and older who received a liver or kidney
transplant as a pediatric patient, and had not yet transitioned to adult care, were
provided with a standard assessment and education. A follow up phone call with
focused questions to assess for retention of education was completed at least 4 weeks
later. The Ebbinghaus Forgetting Curve was used for retention of staff education.
Results: Thirteen patients participated in the initial education and 100% completed the
follow up phone call. The target for retention was an 80% retention rate and we
achieved this in 3 of the 5 areas targeted. There was need for reeducation in the other 2
areas, and increased attention to retention in general.
Conclusions: These results support the adoption of this process into our standard
clinical practice with ongoing assessment of the progression and adjustment of the
education provided. Efforts aimed at increasing retention rates will include utilizing the
Ebbinghaus Forgetting Curve in the patient population in addition to staff.