Pediatric Heart Transplantation

Transitioning to Adult Care (TRANSIT): Feasibility of a Pilot Randomized Controlled Trial

Kathleen L Grady*, Adin Cristian Andrei, Tamara Shankel, Richard Chinnock, Shelley D. Miyamoto, Amrut V. Ambardekar, Allen Sawyer Anderson, Linda Addonizio, Farhana Latif, Debra Lefkowitz, Lee R. Goldberg, Seth A. Hollander, Michael Pham, Kathleen Van't Hof, Jill A Weissberg Benchell, Clyde W Yancy, Menghan Liu, Nichole Melody, Elfriede Pahl

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: Young-adult heart transplant recipients transferring to adult care are at risk for poor health outcomes. We conducted a pilot randomized controlled trial to determine the feasibility of and to test a transition intervention for young adults who underwent heart transplantation as children and then transferred to adult care. Methods: Participants were randomized to the transition intervention (4 months long, focused on heart-transplant knowledge, self-care, self-advocacy, and social support) or usual care. Self-report questionnaires and medical records data were collected at baseline and 3 and 6 months after the initial adult clinic visit. Longitudinal analyses comparing outcomes over time were performed using generalized estimating equations and linear mixed models. Results: Transfer to adult care was successful and feasible (ie, excellent participation rates). The average patient standard deviation of mean tacrolimus levels was similar over time in both study arms and < 2.5, indicating adequate adherence. There were no between-group or within-group differences in percentage of tacrolimus bioassays within target range (> 50%). Average overall adherence to treatment was similarly good in both groups. Rates of appointment keeping through 6 months after transfer declined over time in both groups. Conclusions: The feasibility of the study was demonstrated. Our transition intervention did not improve outcomes.

Original languageEnglish (US)
JournalJournal of Cardiac Failure
DOIs
StatePublished - Jan 1 2019

Fingerprint

Transition to Adult Care
Heart Transplantation
Randomized Controlled Trials
Pediatrics
Young Adult
Feasibility Studies
Tacrolimus
Ambulatory Care
Self Care
Social Support
Self Report
Medical Records
Linear Models
Appointments and Schedules
Arm
Transplants
Health
Therapeutics

Keywords

  • Heart transplantation
  • Transition program

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Grady, Kathleen L ; Andrei, Adin Cristian ; Shankel, Tamara ; Chinnock, Richard ; Miyamoto, Shelley D. ; Ambardekar, Amrut V. ; Anderson, Allen Sawyer ; Addonizio, Linda ; Latif, Farhana ; Lefkowitz, Debra ; Goldberg, Lee R. ; Hollander, Seth A. ; Pham, Michael ; Van't Hof, Kathleen ; Weissberg Benchell, Jill A ; Yancy, Clyde W ; Liu, Menghan ; Melody, Nichole ; Pahl, Elfriede. / Pediatric Heart Transplantation : Transitioning to Adult Care (TRANSIT): Feasibility of a Pilot Randomized Controlled Trial. In: Journal of Cardiac Failure. 2019.
@article{fe46e8d339934514b074f6b49535e6ae,
title = "Pediatric Heart Transplantation: Transitioning to Adult Care (TRANSIT): Feasibility of a Pilot Randomized Controlled Trial",
abstract = "Background: Young-adult heart transplant recipients transferring to adult care are at risk for poor health outcomes. We conducted a pilot randomized controlled trial to determine the feasibility of and to test a transition intervention for young adults who underwent heart transplantation as children and then transferred to adult care. Methods: Participants were randomized to the transition intervention (4 months long, focused on heart-transplant knowledge, self-care, self-advocacy, and social support) or usual care. Self-report questionnaires and medical records data were collected at baseline and 3 and 6 months after the initial adult clinic visit. Longitudinal analyses comparing outcomes over time were performed using generalized estimating equations and linear mixed models. Results: Transfer to adult care was successful and feasible (ie, excellent participation rates). The average patient standard deviation of mean tacrolimus levels was similar over time in both study arms and < 2.5, indicating adequate adherence. There were no between-group or within-group differences in percentage of tacrolimus bioassays within target range (> 50{\%}). Average overall adherence to treatment was similarly good in both groups. Rates of appointment keeping through 6 months after transfer declined over time in both groups. Conclusions: The feasibility of the study was demonstrated. Our transition intervention did not improve outcomes.",
keywords = "Heart transplantation, Transition program",
author = "Grady, {Kathleen L} and Andrei, {Adin Cristian} and Tamara Shankel and Richard Chinnock and Miyamoto, {Shelley D.} and Ambardekar, {Amrut V.} and Anderson, {Allen Sawyer} and Linda Addonizio and Farhana Latif and Debra Lefkowitz and Goldberg, {Lee R.} and Hollander, {Seth A.} and Michael Pham and {Van't Hof}, Kathleen and {Weissberg Benchell}, {Jill A} and Yancy, {Clyde W} and Menghan Liu and Nichole Melody and Elfriede Pahl",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.cardfail.2019.06.011",
language = "English (US)",
journal = "Journal of Cardiac Failure",
issn = "1071-9164",
publisher = "Churchill Livingstone",

}

Grady, KL, Andrei, AC, Shankel, T, Chinnock, R, Miyamoto, SD, Ambardekar, AV, Anderson, AS, Addonizio, L, Latif, F, Lefkowitz, D, Goldberg, LR, Hollander, SA, Pham, M, Van't Hof, K, Weissberg Benchell, JA, Yancy, CW, Liu, M, Melody, N & Pahl, E 2019, 'Pediatric Heart Transplantation: Transitioning to Adult Care (TRANSIT): Feasibility of a Pilot Randomized Controlled Trial', Journal of Cardiac Failure. https://doi.org/10.1016/j.cardfail.2019.06.011

Pediatric Heart Transplantation : Transitioning to Adult Care (TRANSIT): Feasibility of a Pilot Randomized Controlled Trial. / Grady, Kathleen L; Andrei, Adin Cristian; Shankel, Tamara; Chinnock, Richard; Miyamoto, Shelley D.; Ambardekar, Amrut V.; Anderson, Allen Sawyer; Addonizio, Linda; Latif, Farhana; Lefkowitz, Debra; Goldberg, Lee R.; Hollander, Seth A.; Pham, Michael; Van't Hof, Kathleen; Weissberg Benchell, Jill A; Yancy, Clyde W; Liu, Menghan; Melody, Nichole; Pahl, Elfriede.

In: Journal of Cardiac Failure, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Pediatric Heart Transplantation

T2 - Transitioning to Adult Care (TRANSIT): Feasibility of a Pilot Randomized Controlled Trial

AU - Grady, Kathleen L

AU - Andrei, Adin Cristian

AU - Shankel, Tamara

AU - Chinnock, Richard

AU - Miyamoto, Shelley D.

AU - Ambardekar, Amrut V.

AU - Anderson, Allen Sawyer

AU - Addonizio, Linda

AU - Latif, Farhana

AU - Lefkowitz, Debra

AU - Goldberg, Lee R.

AU - Hollander, Seth A.

AU - Pham, Michael

AU - Van't Hof, Kathleen

AU - Weissberg Benchell, Jill A

AU - Yancy, Clyde W

AU - Liu, Menghan

AU - Melody, Nichole

AU - Pahl, Elfriede

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Young-adult heart transplant recipients transferring to adult care are at risk for poor health outcomes. We conducted a pilot randomized controlled trial to determine the feasibility of and to test a transition intervention for young adults who underwent heart transplantation as children and then transferred to adult care. Methods: Participants were randomized to the transition intervention (4 months long, focused on heart-transplant knowledge, self-care, self-advocacy, and social support) or usual care. Self-report questionnaires and medical records data were collected at baseline and 3 and 6 months after the initial adult clinic visit. Longitudinal analyses comparing outcomes over time were performed using generalized estimating equations and linear mixed models. Results: Transfer to adult care was successful and feasible (ie, excellent participation rates). The average patient standard deviation of mean tacrolimus levels was similar over time in both study arms and < 2.5, indicating adequate adherence. There were no between-group or within-group differences in percentage of tacrolimus bioassays within target range (> 50%). Average overall adherence to treatment was similarly good in both groups. Rates of appointment keeping through 6 months after transfer declined over time in both groups. Conclusions: The feasibility of the study was demonstrated. Our transition intervention did not improve outcomes.

AB - Background: Young-adult heart transplant recipients transferring to adult care are at risk for poor health outcomes. We conducted a pilot randomized controlled trial to determine the feasibility of and to test a transition intervention for young adults who underwent heart transplantation as children and then transferred to adult care. Methods: Participants were randomized to the transition intervention (4 months long, focused on heart-transplant knowledge, self-care, self-advocacy, and social support) or usual care. Self-report questionnaires and medical records data were collected at baseline and 3 and 6 months after the initial adult clinic visit. Longitudinal analyses comparing outcomes over time were performed using generalized estimating equations and linear mixed models. Results: Transfer to adult care was successful and feasible (ie, excellent participation rates). The average patient standard deviation of mean tacrolimus levels was similar over time in both study arms and < 2.5, indicating adequate adherence. There were no between-group or within-group differences in percentage of tacrolimus bioassays within target range (> 50%). Average overall adherence to treatment was similarly good in both groups. Rates of appointment keeping through 6 months after transfer declined over time in both groups. Conclusions: The feasibility of the study was demonstrated. Our transition intervention did not improve outcomes.

KW - Heart transplantation

KW - Transition program

UR - http://www.scopus.com/inward/record.url?scp=85069732226&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85069732226&partnerID=8YFLogxK

U2 - 10.1016/j.cardfail.2019.06.011

DO - 10.1016/j.cardfail.2019.06.011

M3 - Article

JO - Journal of Cardiac Failure

JF - Journal of Cardiac Failure

SN - 1071-9164

ER -