Background: Adolescents and young adults experience the poorest long-term graft survival after kidney transplantation (KTx) due to non-adherence and other causes. KTx360° is a multicenter, multimodal, telemedicine-based follow-up care model designed to improve transplant survival in adult and pediatric patients.
Methods/study design: The pediatric part of the study was conducted in the study center Hannover from May 2017 to October 2020, under the trial registration ISRCTN29416382. The structured post-transplant care model included specialized case management, telemedicine support, psychological and exercise assessments with targeted interventions. Two endpoints were defined: graft failure and adherence behavior, including the tacrolimus variation coefficient and the BASSIS scale. In a quasi-experimental, prospective, observational study, adherence behavior was described using study data. Longitudinal claims data was used from participating statutory health insurance (SHI) providers to investigate graft failure in comparison of the intention-to-treat group (patients transplanted after 2017; ITT) to historical data (patients transplanted between 2012 and 2017; hist_CG) and two external control groups (controls transplanted after 2017 (ext_CG) resp. between 2012-2017 in other KTx centers (ext_hist_CG)). Descriptive analyses were performed reporting 95% confidence intervals.
Results: We recruited 72 children/adolescents of whom 26 were incident (enrolled within the first year after KTx) and 46 prevalent (enrolled >1 year after KTx) participants. Due to differences in the availability of claims data, data of 22 patients in the ITT, of 17 in the hist_CG, of 71 in the ext_CG and of 68 in the ext_hist_CG could be analyzed. In the first years of aftercare, we observed complete adherence behavior in both prevalent and incident participants. However, we noted a trend toward increasing non-adherence of prevalent participants compared to incident participants. During the first year after transplantation, we did not find any graft failure in the ITT and hist_CG (both from Hannover before and after implementation of KTx360°) and low levels of graft failure (3-6%) in the external controls (ext_CG and ext_hist_CG, other KTx centers)
Conclusion: We observed slight trends of increasing non-adherence among prevalent participants. Adherence levels remained consistently high across all groups. No graft failures were recorded in the study center before and after the implementation of KTx360°. Graft survival and adherence were significantly better in the pediatric participants than in adults (2.3 and 5.8% in prevalent/incident). Although we could show no short-term effects, it is valid to speculate that adherence-enhancing and individualized therapies based on telemedicine may potentially be effective over the long term when rejections rates also increase in adolescents.