Navigating Adulthood with Maple Syrup Urine Disease: Patient and Caregiver Perspectives on Healthcare Transition and Independent Living

Background: Medical advances in diagnosis and management have increased the life expectancy of many pediatric-onset rare diseases, including inherited metabolic disorders (IMDs). Historically fatal childhood conditions are now manageable chronic illnesses, with over 90% of individuals with IMD reaching adulthood. As more individuals with IMDs reach adulthood (age 18 years), there is a new imperative for health care transition planning that promotes developmentally-appropriate skills for medical self-management and independent living. Knowledge gaps on the long-term disease-related outcomes limit our ability to provide evidence-based resources for transition. Maple Syrup Urine Disease (MSUD) is an IMD with a global incidence of 1:185,000. It is typically diagnosed through population-level newborn screening, which allows for early treatment of dietary restrictions of branched chain amino acids and urgent intervention during episodes of catabolic stress. Due to the success of newborn screening program, there is a growing population of adults with MSUD, making it a model for exploring the current state of transition and adult outcomes in IMDs. Results: We used a qualitative case study approach to assess the lived experiences of adults with MSUD (n=10) or caregivers to adults with MSUD (n=8). Analysis of their semi-structured interviews identified common themes including: (1) poor, non-standardized health care transition; (2) less emphasis on dietary management; (3) changing symptomatology with new presentations of fatigue, brain fog, and panic attacks; (3) emerging concerns related to adult health care, including comorbid adult-onset conditions, mental health, and lack of knowledgeable adult providers; (4) wide ranging functional outcomes for education, employment, and financial independence; and (5) meeting new milestones including romantic partnership and parenthood; and (6) greater concern about the supports needed to achieve independent living. Conclusions: Individuals with MSUD are reaching milestones of adulthood and have new priorities for their healthcare and lifestyle. Evidence-based healthcare transition is needed to support their transition to independent living.