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Post-transplant education for kidney recipients and their caregivers

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Abstract

Successful outcomes in pediatric kidney transplantation require the involvement of the transplant team as well as recipients and their caregivers. Enhancing patient and family understanding of the disease and of post-transplant care can result in improved adherence and outcomes. Educational strategies should aim to be broad, understandable, innovative, and inclusive while maintaining a tailored approach to individualized care. Teaching should not be viewed as a one-time event but rather as an ongoing conversation throughout the duration of care, emphasizing different aspects throughout the patient’s various developmental stages. The following review article discusses the content and methods of post-transplant education.

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References

  1. Brosig C, Pai A, Fairey E, Krempien J, McBride M, Lefkowitz DS (2014) Child and family adjustment following pediatric solid organ transplantation: factors to consider during the early years post-transplant. Pediatr Transplant 18:559–567. https://doi.org/10.1111/petr.1228

    Article  PubMed  Google Scholar 

  2. (2017) Ecology of Health and Medicine. https://blogs.uw.edu/somehm/2017/07/12/key-ethics-term-adherence-vs-compliance/. Accessed 30 August 2022

  3. Steinberg EA, Moss M, Buchanan CL, Goebel J (2018) Adherence in pediatric kidney transplant recipients: solutions for the system. Pediatr Nephrol 33:361–372. https://doi.org/10.1007/s00467-017-3637-0

    Article  PubMed  Google Scholar 

  4. Delucchi A, Gutierrez H, Arrellano P, Slater C, Meneses M, López I (2008) Factors that influence nonadherence in immunosuppressant treatment in pediatric transplant recipients: a proposal for an educational strategy. Transplant Proc 40:3241–3243. https://doi.org/10.1016/j.transproceed.2008.03.125

    Article  CAS  PubMed  Google Scholar 

  5. Rianthavorn P, Ettenger RB (2005) Medication non-adherence in the adolescent renal transplant recipient: a clinician’s viewpoint. Pediatr Transplant 9:398–407. https://doi.org/10.1111/j.1399-3046.2005.00358.x.PMID

    Article  CAS  PubMed  Google Scholar 

  6. Dobbels F, Ruppar T, De Geest S, Decorte A, Van Damme-Lombaerts R, Fine RN (2010) Adherence to the immunosuppressive regimen in pediatric kidney transplant recipients: a systematic review. Pediatr Transplant 14:603–613. https://doi.org/10.1111/j.1399-3046.2010.01299.x

    Article  CAS  PubMed  Google Scholar 

  7. Foster BJ, Dahhou M, Zhang X, Platt RW, Samuel SM, Hanley JA (2011) Association between age and graft failure rates in young kidney transplant recipients. Transplantation 92:1237–1243. https://doi.org/10.1097/TP.0b013e31823411d7

    Article  PubMed  Google Scholar 

  8. Low JK, Williams A, Manias E, Crawford K (2015) Interventions to improve medication adherence in adult kidney transplant recipients: a systematic review. Nephrol Dial Transplant 30:752–761. https://doi.org/10.1093/ndt/gfu204

    Article  PubMed  Google Scholar 

  9. Bell LE, Sawyer SM (2010) Transition of care to adult services for pediatric solid-organ transplant recipients. Pediatr Clin North Am 57:593–610. https://doi.org/10.1016/j.pcl.2010.01.007

    Article  PubMed  Google Scholar 

  10. Boucquemont J, Pai ALH, Dharnidharka VR, Hebert D, Zelikovsky N, Amaral S, Furth SL, Foster BJ (2020) Association between day of the week and medication adherence among adolescent and young adult kidney transplant recipients. Am J Transplant 20:274–281. https://doi.org/10.1111/ajt.15590

    Article  PubMed  Google Scholar 

  11. World Health Organization (2003) Adherence to long-term therapies: evidence for action. https://apps.who.int/iris/handle/10665/42682. Accessed 30 August 2022

  12. Patzer RE, Serper M, Reese PP, Przytula K, Koval R, Ladner DP, Levitsky JM, Abecassis MM, Wolf MS (2016) Medication understanding, non-adherence, and clinical outcomes among adult kidney transplant recipients. Clin Transplant 30:1294–1305. https://doi.org/10.1111/ctr.12821

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Skelton SL, Waterman AD, Davis LA, Peipert JD, Fish AF (2015) Applying best practices to designing patient education for patients with end-stage renal disease pursuing kidney transplant. Prog Transplant 25:77–84. https://doi.org/10.7182/pit2015415

    Article  PubMed  PubMed Central  Google Scholar 

  14. Fine RN, Becker Y, De Geest S, Eisen H, Ettenger R, Evans R, Rudow DL, McKay D, Neu A, Nevins T, Reyes J, Wray J, Dobbels F (2009) Nonadherence consensus conference summary report. Am J Transplant 9:35–41. https://doi.org/10.1111/j.1600-6143.2008.02495.x

    Article  CAS  PubMed  Google Scholar 

  15. De Bleser L, Matteson M, Dobbels F, Russell C, De Geest S (2009) Interventions to improve medication-adherence after transplantation: a systematic review. Transpl Int 22:780–797. https://doi.org/10.1111/j.1432-2277.2009.00881.x

    Article  PubMed  Google Scholar 

  16. Pruette CS, Amaral S (2021) Empowering patients to adhere to their treatment regimens: a multifaceted approach. Pediatr Transplant 25:e13849. 0.1111/petr.13849

  17. Chisholm MA (2002) Enhancing transplant patients’ adherence to medication therapy. Clin Transplant 16:30–38. https://doi.org/10.1034/j.1399-0012.2002.00104.x

    Article  PubMed  Google Scholar 

  18. Chisholm-Burns M, Pinsky B, Parker G, Johnson P, Arcona S, Buzinec P, Chakravarti P, Good M, Cooper M (2012) Factors related to immunosuppressant medication adherence in renal transplant recipients. Clin Transplant 26:706–713. https://doi.org/10.1111/j.1399-0012.2011.01589.x

    Article  PubMed  Google Scholar 

  19. Russell CL, Hathaway D, Remy LM, Aholt D, Clark D, Miller C, Ashbaugh C, Wakefield M, Ye S, Staggs VS, Ellis RJ, Goggin K (2019) Improving medication adherence and outcomes in adult kidney transplant patients using a personal systems approach: SystemCHANGE™ results of the MAGIC randomized clinical trial. Am J Transplant 20:125–136. https://doi.org/10.1111/ajt.15528

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Kim S, Ju MK, Son S, Jun S, Lee SY, Han CS (2020) Development of video-based educational materials for kidney-transplant patients. PLoS One 15:e0236750. https://doi.org/10.1371/journal.pone.0236750

  21. Chandar JJ, Ludwig DA, Aguirre J, Mattiazzi A, Bielecka M, Defreitas M, Delamater AM (2019) Assessing the link between modified “teach back” method and improvement in knowledge of the medical regimen among youth with kidney transplants: the application of digital media. Patient Educ Couns 102:1035–1039. https://doi.org/10.1016/j.pec.2018.12.007

    Article  PubMed  Google Scholar 

  22. Waterman AD, Robbins ML, Paiva AL, Peipert JD, Kynard-Amerson CS, Goalby CJ, Davis LA, Thein JL, Schenk EA, Baldwin KA, Skelton SL, Amoyal NR, Brick LA (2014) Your path to transplant: a randomized controlled trial of a tailored computer education intervention to increase living donor kidney transplant. BMC Nephrol 15:166. https://doi.org/10.1186/1471-2369-15-166

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lockwood MB, Dunn-Lopez K, Pauls H, Burke L, Shah SD, Saunders MA (2018) If you build it, they may not come: modifiable barriers to patient portal use among pre- and post-kidney transplant patients. JAMIA Open 1:255–264. https://doi.org/10.1093/jamiaopen/ooy024

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hooper DK, Misurac J, Blydt-Hansen T, Chua AN (2021) Multicenter data to improve health for pediatric renal transplant recipients in North America: complementary approaches of NAPRTCS and IROC. Pediatr Transplant 25:e13891. 0.1111/petr.13891

  25. Foster BJ, Pai ALH, Zelikovsky N, Amaral S, Bell L, Dharnidharka VR, Hebert D, Holly C, Knauper B, Matsell D, Phan V, Rogers R, Smith JM, Zhao H, Furth SL (2018) A randomized trial of a multicomponent intervention to promote medication adherence: the teen adherence in kidney transplant effectiveness of intervention trial (TAKE-IT). Am J Kidney Dis 72:30–41. https://doi.org/10.1053/j.ajkd.2017.12.012.Erratum.In:(2019)AmJKidneyDis73:578

    Article  PubMed  PubMed Central  Google Scholar 

  26. Bastable SB, Myers GM (2016) Developmental stages of the learner. https://nursekey.com/developmental-stages-of-the-learner/. Accessed 30 August 2022

  27. Pacaud D, Crawford S, Stephure DK, Dean HJ, Couch R, Dewey D (2007) Effect of type 1 diabetes on psychosocial maturation in young adults. J Adolesc Health 40:29–35. https://doi.org/10.1016/j.jadohealth.2006.07.003

    Article  PubMed  Google Scholar 

  28. Watson AR (2000) Non-compliance and transfer from paediatric to adult transplant unit. Pediatr Nephrol 14:469–472. https://doi.org/10.1007/s004670050794

    Article  CAS  PubMed  Google Scholar 

  29. Bartosh S, Dipchand A, Chavers B (2022) Pediatric kidney transplantation: a guide for patients and families. https://power2save.org/pediatric-kidney-transplant-a-guide-for-patients-and-families. Accessed 30 August 2022

  30. Backes C, Moyano C, Rimaud C, Bienvenu C, Schneider MP (2021) Digital medication adherence support: could healthcare providers recommend mobile health apps? Front Med Technol 2:616242. https://doi.org/10.3389/fmedt.2020.616242

    Article  PubMed  PubMed Central  Google Scholar 

  31. Pérez-Jover V, Sala-González M, Guilabert M, Mira JJ (2019) Mobile apps for increasing treatment adherence: systematic review. J Med Internet Res 21:e12505. https://doi.org/10.2196/12505

    Article  PubMed  PubMed Central  Google Scholar 

  32. Hart A, Lentine KL, Smith JM, Miller JM, Skeans MA, Prentice M, Robinson A, Foutz J, Booker SE, Israni AK, Hirose R, Snyder JJ (2021) OPTN/SRTR 2019 annual data report: kidney. Am J Transplant 21(Suppl 2):21–137. https://doi.org/10.1111/ajt.16502

    Article  PubMed  Google Scholar 

  33. Iwasaki K (2007) Metabolism of tacrolimus (FK506) and recent topics in clinical pharmacokinetics. Drug Metab Pharmacokinet 22:328–335. https://doi.org/10.2133/dmpk.22.328

    Article  CAS  PubMed  Google Scholar 

  34. McGhee B, McCombs JR, Boyle G, Webber SA, Reyes JR (1997) Therapeutic use of an extemporaneously prepared oral suspension of tacrolimus in pediatric patients. Transplantation 64:941–942. https://doi.org/10.1097/00007890-199709270-00030

    Article  CAS  PubMed  Google Scholar 

  35. Kim M, Rostas S, Gabardi S (2013) Mycophenolate fetal toxicity and risk evaluation and mitigation strategies. Am J Transplant 13:1383–1389. https://doi.org/10.1111/ajt.12238

    Article  CAS  PubMed  Google Scholar 

  36. Albert J, Hanisch B, Sgambat K (2021) Approaches to safe living and diet after solid organ transplantation. Pediatr Transplant 25:e13783. https://doi.org/10.1111/petr.13783

    Article  PubMed  Google Scholar 

  37. Suresh S, Upton J, Green M, Pham-Huy A, Posfay-Barbe KM, Michaels MG, Top KA, Avitzur Y, Burton C, Chong PP, Danziger-Isakov L, Dipchand AI, Hébert D, Kumar D, Morris SK, Nalli N, Ng VL, Nicholas SK, Robinson JL, Solomon M, Tapiero B, Verma A, Walter JE, Allen UD (2019) Live vaccines after pediatric solid organ transplant: proceedings of a consensus meeting, 2018. Pediatr Transplant 23:e13571. https://doi.org/10.1111/petr.13571

    Article  PubMed  Google Scholar 

  38. Centers for Disease Control and Prevention (2022) Child and adolescent immunization schedule. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html. Accessed 30 August 2022

  39. Kelgeri C, Kelly DF, Brant A, Patel M, Gupte GL (2021) Principles of immunisation in children with solid organ transplant. Arch Dis Child 106:219–223. https://doi.org/10.1136/archdischild-2020-319822

    Article  PubMed  Google Scholar 

  40. Chen JK, Cheng J, Liverman R, Serluco A, Corbo H, Yildirim I (2022) Vaccination in pediatric solid organ transplant: a primer for the immunizing clinician. Clin Transplant 36:e14577. https://doi.org/10.1111/ctr.14577

    Article  CAS  PubMed  Google Scholar 

  41. Danziger-Isakov L, Kumar D; AST ID Community of Practice (2019) Vaccination of solid organ transplant candidates and recipients: guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 33:e13563. https://doi.org/10.1111/ctr.13563. Erratum in (2020) Clin Transplant 34:e13806

  42. Fox TG, Nailescu C (2019) Vaccinations in pediatric kidney transplant recipients. Pediatr Nephrol 34:579–591. https://doi.org/10.1007/s00467-018-3953-z

    Article  PubMed  Google Scholar 

  43. Hirzel C, Kumar D (2018) Influenza vaccine strategies for solid organ transplant recipients. Curr Opin Infect Dis 31:309–315. https://doi.org/10.1097/QCO.0000000000000461

    Article  PubMed  Google Scholar 

  44. Boyarsky BJ, Werbel WA, Avery RK, Tobian AAR, Massie AB, Segev DL, Garonzik-Wang JM (2021) Antibody response to 2-dose SARS-CoV-2 mRNA vaccine series in solid organ transplant recipients. JAMA 325:2204–2206. https://doi.org/10.1001/jama.2021.7489

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Ardura MI, Coscia LA, Meyers MR (2021) Promoting safe sexual practices and sexual health maintenance in pediatric and young adult solid organ transplant recipients. Pediatr Transplant 25:e13949. https://doi.org/10.1111/petr.13949

    Article  PubMed  Google Scholar 

  46. Szpotanska-Sikorska M, Pietrzak B, Wielgos M (2014) Contraceptive awareness and birth control selection in female kidney and liver transplant recipients. Contraception 90:435–439. https://doi.org/10.1016/j.contraception.2014.04.014

    Article  PubMed  Google Scholar 

  47. Sarkar M, Bramham K, Moritz MJ, Coscia L (2018) Reproductive health in women following abdominal organ transplant. Am J Transplant 8:1068–1076. https://doi.org/10.1111/ajt.14697

    Article  Google Scholar 

  48. French VA, Davis JS, Sayles HS, Wu SS (2013) Contraception and fertility awareness among women with solid organ transplants. Obstet Gynecol 122:809–814. https://doi.org/10.1097/AOG.0b013e3182a5eda9

    Article  PubMed  PubMed Central  Google Scholar 

  49. Krajewski C, Sucato G (2014) Reproductive health care after transplantation. Best Pract Res Clin Obstet Gynaecol 28:1222–1234. https://doi.org/10.1016/j.bpobgyn.2014.09.002

    Article  PubMed  Google Scholar 

  50. Ashoor I, Aviles D, Pasternak R, Vehaskari VM (2015) Sexually transmitted infections in pediatric renal transplant recipients: time to take notice! Pediatr Transplant 19:584–587. https://doi.org/10.1111/petr.12554

    Article  PubMed  Google Scholar 

  51. Lee KC, Ngo-Metzger Q, Wolff T, Chowdhury J, LeFevre ML, Meyers DS (2016) Sexually transmitted infections: recommendations from the U.S. Preventive Services Task Force. Am Fam Physician 94:907–915

    PubMed  Google Scholar 

  52. Monnin K, Lofton AM, Naclerio C, Buchanan CL, Campbell K, Tenenbaum RB, Steinberg Christofferson E (2021) Understanding substance use policies and associated ethical concerns: a survey of pediatric transplant centers. Pediatr Transplant 25:e13984. https://doi.org/10.1111/petr.13984

    Article  PubMed  Google Scholar 

  53. Substance Abuse and Mental Health Services Administration (2020) Key substance use and mental health indicators in the United States: results from the 2019 National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR090120.htm. Accessed 30 August 2022

  54. Wisk LE, Weitzman ER (2016) Substance use patterns through early adulthood: results for youth with and without chronic conditions. Am J Prev Med 51:33–45. https://doi.org/10.1016/j.amepre.2016.01.029

    Article  PubMed  PubMed Central  Google Scholar 

  55. Weitzman ER, Salimian PK, Rabinow L, Levy S (2019) Perspectives on substance use among youth with chronic medical conditions and implications for clinical guidance and prevention: a qualitative study. PLoS One 14:e0209963. https://doi.org/10.1371/journal.pone.0209963

  56. Hayde N (2021) Substance use and abuse in pediatric transplant recipients: what the transplant provider needs to know. Pediatr Transplant 25:e13877. https://doi.org/10.1111/petr.13877

    Article  PubMed  Google Scholar 

  57. Barclay RP, Hilt RJ (2016) Integrated care for pediatric substance abuse. Child Adolesc Psychiatr Clin N Am 25:769–777. https://doi.org/10.1016/j.chc.2016.05.007

    Article  PubMed  Google Scholar 

  58. Lunstead J, Weitzman ER, Harstad E, Dedeoglu F, Gaffin JM, Garvey KC, MacGinnitie A, Rufo PA, Fishman LN, Wisk LE, Levy S (2019) Screening and counseling for alcohol use in adolescents with chronic medical conditions in the ambulatory setting. J Adolesc Health 64:804–806. https://doi.org/10.1016/j.jadohealth.2019.02.011

    Article  PubMed  PubMed Central  Google Scholar 

  59. Anthony SJ, Pollock Barziv S, Ng VL (2010) Quality of life after pediatric solid organ transplantation. Pediatr Clin North Am 57:559–574. https://doi.org/10.1016/j.pcl.2010.01.006

    Article  PubMed  Google Scholar 

  60. Bobrowski AE (2021) School and sports participation post-transplant. Pediatr Transplant 25:e13791. https://doi.org/10.1111/petr.13791

    Article  PubMed  Google Scholar 

  61. Warady BA, Carr B, Hellerstein S, Alon U (1992) Residential summer camp for children with end-stage renal disease. Child Nephrol Urol 12:212–215

    CAS  PubMed  Google Scholar 

  62. Improving Renal Outcomes Collaborative (2022) Resources. https://www.irocnow.org/resources. Accessed 30 August 2022

  63. Wolf MF, George RP, Warshaw B, Wang E, Greenbaum LA (2016) Physical activity and kidney injury in pediatric and young adult kidney transplant recipients. J Pediatr 79:90-95.e2. https://doi.org/10.1016/j.jpeds.2016.08.079

    Article  Google Scholar 

  64. Committee on Sports Medicine and Fitness (2001) American Academy of Pediatrics: medical conditions affecting sports participation. Pediatrics 107:1205–1209. https://doi.org/10.1542/peds.107.5.1205

    Article  Google Scholar 

  65. Papagiannopoulos D, Gong E (2017) Revisiting sports precautions in children with solitary kidneys and congenital anomalies of the kidney and urinary tract. Urology 101:9–14. https://doi.org/10.1016/j.urology.2016.11.025

    Article  PubMed  Google Scholar 

  66. Grinsell MM, Showalter S, Gordon KA, Norwood VF (2006) Single kidney and sports participation: perception versus reality. Pediatrics 118:1019–1027. https://doi.org/10.1542/peds.2006-0663

    Article  PubMed  Google Scholar 

  67. Charnaya O, Moudgil A (2017) Hypertension in the pediatric kidney transplant recipient. Front Pediatr 5:86. https://doi.org/10.3389/fped.2017.00086

    Article  PubMed  PubMed Central  Google Scholar 

  68. Abushammala I (2021) Tacrolimus and herbs interactions: a review. Pharmazie 76:468–472. https://doi.org/10.1691/ph.2021.1684

    Article  CAS  PubMed  Google Scholar 

  69. Khuu T, Hickey A, Deng MC (2013) Pomegranate-containing products and tacrolimus: a potential interaction. J Heart Lung Transplant 32:272–274. https://doi.org/10.1016/j.healun.2012.10.015

    Article  PubMed  Google Scholar 

  70. United States Department of Agriculture (2019) Food safety. https://www.fsis.usda.gov/sites/default/files/media_file/2021-04/at-risk-booklet.pdf. Accessed 30 August 2022

  71. Sgambat K, Clauss S, Moudgil A (2018) Comparison of BMI, waist circumference, and waist-to-height ratio for identification of subclinical cardiovascular risk in pediatric kidney transplant recipients. Pediatr Transplant 22:e13300. https://doi.org/10.1111/petr.13300

    Article  CAS  PubMed  Google Scholar 

  72. Stabouli S, Polderman N, Nelms CL, Paglialonga F, Oosterveld MJS, Greenbaum LA, Warady BA, Anderson C, Haffner D, Desloovere A, Qizalbash L, Renken-Terhaerdt J, Tuokkola J, Walle JV, Shaw V, Mitsnefes M, Shroff R (2022) Assessment and management of obesity and metabolic syndrome in children with CKD stages 2–5 on dialysis and after kidney transplantation-clinical practice recommendations from the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol 37:1–20. https://doi.org/10.1007/s00467-021-05148-y

    Article  PubMed  Google Scholar 

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  1. Department of Pediatrics, Cohen Children’s Medical Center–Long Island Jewish Medical Center, 269-01 76th Ave, New Hyde Park, NY, 11040, USA

    Pamela Singer

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Singer, P. Post-transplant education for kidney recipients and their caregivers. Pediatr Nephrol 38, 2033–2042 (2023). https://doi.org/10.1007/s00467-022-05744-6

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