Growing up in a virtual world - A new look for transitioning to adult transplant care.

adolescent and young adult

Transition‐to‐Adult‐Care T2AC

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

AYA solid organ transplant recipients are confronted with unique life stressors that may negatively impact allograft outcomes. Regardless of age at time of transplant, AYA transplant recipients have a higher risk of graft loss compared with other age groups, partly related to medical non‐adherence. , Transition from pediatric to adult health care often occurs during, and potentially intensifying, this challenging time. The global COVID‐19 pandemic has compounded anxiety and stressors surrounding major life events, adding uncertainty and lack of normalcy for this population. Fortunately, pediatric solid organ transplant recipients with COVID‐19 infection appear to have a similar prognosis to immunocompetent peers ; however, the pandemic has impacted post‐transplant management, including reduced access to multidisciplinary care and education/support.

In 2016, our center implemented a comprehensive T2AC curriculum for AYA solid organ transplant recipients at Children’s Hospital Colorado. This curriculum consists of longitudinal education, readiness assessment, outreach programming, and a daylong seminar for AYAs and families focused on education from the pediatric and adult transplant multidisciplinary teams. Comparing AYA recipients transitioned pre‐T2AC, “graduates” of the curriculum demonstrate improved transplant outcomes in the first year following transition as evidenced by decreased rejection episodes, graft loss, loss to follow‐up, ED visits and inpatient admissions, and fewer “bounce‐backs” to the pediatric center.

Recognizing the need to continue preparing our AYA population for transition, we aimed to continue the T2AC curriculum despite limitations created by social distancing. Therefore, we adapted the Transitions Seminar component of the program to a virtual platform. This seminar provided virtual didactic education, presented in an interactive “game show” format, to discuss differences between adult and pediatric care, medication management, insurance and healthcare costs, substance and alcohol use, sexual health, and mental health. As well, breakout sessions allowed for interaction with providers and peers and for support from transplant psychology.

Despite change in structure and platform, virtual programming was implemented with promising results. Participants were invited via mail, MyChart, and phone call. This event boasted the highest attendance to date with 25 AYA recipients (8 kidney, 8 liver, 9 heart; mean age 18 years) plus additional family members, likely due to the convenience of joining from home. Active participation was notably increased, potentially related to multiple modes of interaction (eg, private/group chat message) and minimized anxiety by removing in‐person interaction. A post‐course survey indicated positive reception with an average response of 7.7/10 (10 = Very Likely) to “How likely are you to attend a similar event again in the future?” The average response to “After attending this event, how prepared do you feel for transitioning to adult care?” of 6.7/10, comparable to 7.2 for prior in‐person events, suggests change in venue did not reduce impact. Additional feedback encouraged increased time with adult transplant providers and increased opportunity for questions and answers. Given the overall positive experience, we plan to maintain and grow the virtual nature of our T2AC Seminar through the pandemic and beyond, hoping to broaden our audience and strengthen our educational mission.

AUTHOR CONTRIBUTION

Mary Moss Chandran: Contributed to conceptualization, resources, and writing—drafting and revision; Eliza Blanchette: Contributed to conceptualization, writing—review and editing, and final approval; Adrianne Sikora: Contributed to conceptualization, resources, and writing—review and editing; Megan Bisek: resources, and writing—review and editing; Elizabeth Steinberg Christofferson: Contributed to resources, and writing—review and editing; Margret Bock: Contributed to conceptualization, resources, writing—drafting and revision, and final approval.