Purpose: To effectively transition young adult liver transplant recipients to adult transplant hepatology care through MyPATH, a structured transition program with a collaborative partnership between pediatric and adult providers.
Method: Pediatric and adult transplant providers collaboratively developed a transition/transfer program based on the Six Core Elements of Transition (Got Transition™). Medical criteria for transfer: >3 yrs post-OLTx, and stable graft function with no significant new-onset co-morbidities. Psychosocial criteria: >18 yrs, participated in MyPATH, assessed for transition readiness, and confirmed for transfer by the peds multidisciplinary team in agreement with the youth; goals and timeline confirmed. Insurance is authorized and a release of records obtained. A transfer package (medical summary, recent labs, final peds clinic note, final readiness assessment, operative and path notes) is provided for the adult team. Youth attend a virtual “Meet and Greet” with both teams to introduce the adult team, provide an overview of clinic and differences in care, review current care, and to confirm the first adult clinic date. A member of the pediatric team attends the first clinic to provide continuity during the “warm handoff.” Outcomes are assessed by chart review and coordinator interview at 3, 6, 12, 24, and 36 months after transfer including labs (LFTs, TAC levels/MLVI, plts, BUN, cr), new onset comorbidities, response to medical requests, and level of communication with the coordinator.
Results:  20 youth have transferred care with an additional 18 patients in queue for transfer into early 2023.  All transferred youth have participated in MyPATH and have attended the Meet and Greet session and their first adult clinic.  Outcomes data is available for 18 patients with 3-12 months follow-up:  88.9% have maintained adequate and appropriate contact with their CCTN, 66.7% have obtained labs as requested (frequency of <3 months); one patient did not attend annual clinic at 1 yr post-transfer. 72.2% have stable/baseline LFTs and 66.7% have been adherent with immunosuppression.  Mean MLVI of tac levels was 1.45 (0.65-2.7) for pts with pre/post-transfer levels (n=9). New onset comorbidities: ACR due to nonadherence requiring treatment (n=1), renal transplant (listed pre-transfer; n=1), renal consults (n=2), rheumatology consult (n=1), GI (n=1). In regard to reproductive health, pregnancy occurred post transfer (n=2) with one resulting in a first trimester miscarriage. One patient has requested preconception counseling.  At 13 months post-transfer, a death occurred secondary to IC hemorrhage after a fall with head injury.
Conclusions: Early results suggest that a collaborative partnership between youth and the pediatric and adult care teams coupled with a structured transition program may promote stability and maintain healthy outcomes after transfer. Assessing the patient perspective of the process is warranted and is underway.