(90) Changes in Travel Time Among Pediatric Kidney Transplant Recipients After Transfer to Adult Care

Background: The highest risk of allograft failure for a stable pediatric kidney transplant (KT) recipient is during emerging adulthood (ages 17-24 years). This period overlaps with the age at which adolescent and young adult KT patients transfer from pediatric to adult nephrology for their transplant follow-up care. Previous work by Foster et al. has shown increased risk of allograft failure with younger age at transfer, but little is known about factors that impact age at transfer. One potential factor is travel burden to pediatric transplant providers. The larger number of adult nephrology providers may allow for decreased travel time after transfer, but there is a lack of data on how travel time changes in the real world after transfer occurs.

Objectives: The goals of this study were to evaluate changes in travel time for transplant follow-up care after transfer occurs overall and by transfer age category.

Design/Methods: We performed an observational cohort study using the US Renal Data System (USRDS) to identify pediatric ( < 18 years) KT recipients who were transplanted at and had their first follow-up at a pediatric center, and had a functioning allograft at cohort entry. Patients were categorized into transferring in ages 15-18, 19-21, and 22-25. The drive time by automobile between geocoded coordinates was calculated using the Openrouteservice Directions API. Descriptive statistics were used to summarize the difference in drive time after transferring from pediatric to adult care overall and by transfer age category. A Kruskal-Wallis rank sum test was used to evaluate for differences in travel time changes by transfer age category.

Results: The final cohort included 1,194 eligible patients who transferred care prior to age 26. The median change in drive time from pediatric-care to adult-care was 0 minutes (IQR: -0.824, 3.571). No differences were found in change in drive time from pediatric-care to adult-care by transfer age category (p = 0.08). Surprisingly, ~37% of patients had no change in drive time. About 34% of patients had a reduction in drive time after transfer, with a median reduction of 9.9 minutes (IQR: 3.5, 84.5) and ~30% of patients had an increase in drive time after transfer with a median increase of 5.2 minutes (IQR: 1.4, 16.3).

Conclusions: While some patients experienced large shifts in travel time after transferring from pediatric to adult care, more than a third of patients did not and most that did had relatively small changes in their travel time.