Raina, Rupesh

ABSTRACTBackgroundPediatric organ transplantation is the primary treatment for end‐organ failure. Improving medication adherence and healthcare compliance can decrease healthcare burdens, graft rejection, morbidity, and mortality. Adolescents commonly struggle with non‐adherence, necessitating a smooth transition to adult care. This systematic review aims to assess and evaluate the effectiveness of existing transition tools and models used in the care of pediatric solid organ transplant recipients (pSOTR).MethodsA systematic literature review of studies in electronic databases (PubMed, Google Scholar, and Mendeley) on interventions improving transition in pediatric solid organ transplant recipients (pSOTR) from 2000 to 2022 was conducted. Included studies involved pSOTR before the age of 12 years transitioning to adult care.ResultsA lower proportion of graft acute rejection was observed among pSOTR with more than two transition interventions (10.088%, 95% CI: 0.901%–27.441%, I2 = 85.95%, p < 0.0001, random effects, five studies, n = 155) compared to those with two or fewer interventions (13.892%, 95% CI: 4.588%–27.142%, I2 = 74.73%, p = 0.0014, random effects, six studies, n = 140). Additionally, a significant association was found between transition protocols and lower rejection rates (χ2 = 10.57, p = 0.0011), with multiple protocols showing better outcomes (χ2 = 5.091, p = 0.024). Although adherence scores differed significantly with and without transition protocols (χ2 = 8.75, p = 0.0126), no significant difference was found between single and multiple protocol groups (χ2 = 4.8, p = 0.091).ConclusionThis review identifies various transition models and their impact on adherence and graft rejection, which correlate with morbidity and mortality and influence transplant outcomes. The heterogeneity of data within the current literature necessitates further research to establish causality and develop a standardized transition program aimed at improving patient outcomes.

ABSTRACT Point-of-care ultrasonography (POCUS) has rapidly evolved from a niche technology to an indispensable tool across medical specialties, including nephrology. This evolution is driven by advancements in technology and the visionary efforts of clinicians in emergency medicine and beyond. Recognizing its potential, medical schools are increasingly integrating POCUS into training curricula, emphasizing its role in enhancing diagnostic accuracy and patient care. Despite these advancements, barriers such as limited faculty expertise and ‘lack of’ standardized guidelines hinder widespread adoption and regulation. The International Alliance for POCUS in Nephrology (IAPN), through this position statement, aims to guide nephrologists in harnessing the diagnostic power of POCUS responsibly and effectively. By outlining core competencies, recommending training modalities and advocating for robust quality assurance measures, we envision a future where POCUS enhances nephrology practice globally, ensuring optimal patient outcomes through informed, evidence-based decision-making. International collaboration and education are essential to overcome current challenges and realize the full potential of POCUS in nephrology and beyond.