Kerkar Nanda, Danialifar Tanaz
aKeck School of Medicine, University of Southern California bDivision of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Los Angeles, University of Southern California, Los Angeles, California, USA.
Curr Opin Organ Transplant. 2014 Oct;19(5):480-5. doi: 10.1097/MOT.0000000000000116.
This review highlights the fact that in the current era, the focus of success in pediatric transplantation has moved from short-term to long-term patient and graft survival as well as achieving 'normality' after transplantation.
Advances in surgical techniques, organ allocation, intensive care management, laboratory tests, interventional and diagnostic radiology, immunosuppressive, and antiviral drugs have allowed a larger number of pediatric liver transplant recipients to progress into adulthood. To achieve 'normality' several medical and psychosocial factors have become the target of intervention. Attaining optimal linear growth and puberty after transplant is important as is minimizing adverse events associated with immunosuppression. Special considerations are important in the adolescent transplant recipient, particularly adherence to medical recommendations. Liver transplant recipients have been reported to have below average intelligence quotient at school entry and significantly lower health-related quality of life than healthy controls and appropriate interventions need to be put in place early. Successful long-term outcomes in transplantation are contingent on successful transition from pediatric to adult healthcare services. Achieving operational tolerance remains a goal.
In conclusion, this review outlines the myriad issues around pediatric transplantation that can be addressed so that the transplant recipient may experience a 'normal' quality of life.
本综述强调了在当前时代，小儿移植成功的重点已从短期的患者和移植物存活，转向长期存活以及移植后实现“正常状态”。
手术技术、器官分配、重症监护管理、实验室检查、介入和诊断放射学、免疫抑制及抗病毒药物方面的进展，使更多小儿肝移植受者能够步入成年期。为实现“正常状态”，若干医学和社会心理因素已成为干预目标。移植后实现最佳线性生长和青春期发育很重要，尽量减少与免疫抑制相关的不良事件同样重要。对于青少年移植受者，特殊考量很重要，尤其是坚持医学建议。据报道，肝移植受者入学时智商低于平均水平，与健康对照相比，其健康相关生活质量显著更低，需要尽早采取适当干预措施。移植的长期成功结果取决于从儿科医疗服务顺利过渡到成人医疗服务。实现操作耐受仍是一个目标。
总之，本综述概述了小儿移植周围众多可解决的问题，以便移植受者能够体验“正常”的生活质量。
