Mitchell Tim, Gooding Hannah, Mews Cathy, Adams Leon, MacQuillan Gerry, Garas George, Ravikumara Madhur, Lopez Ainslie, Collins Megan, Jeffrey Gary
Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, WA, Australia.
Department of Gastroenterology, Princess Margaret Hospital for Children, Perth, WA, Australia.
Pediatr Transplant. 2017 Feb;21(1). doi: 10.1111/petr.12820. Epub 2016 Oct 20.
Transition to adult care is a vulnerable period for pediatric transplant recipients and is associated with reduced medication compliance, graft loss, and increased mortality. Psychosocial outcomes in young adults differ between pediatric transplant recipients and their healthy peers. We conducted a single-center, retrospective cohort study of all pediatric liver transplant recipients who were transitioned through our center. This study aimed to assess the outcomes of transitioned pediatric liver transplant recipients at an Australian center, including mortality, adherence, and psychosocial morbidity. The 1- and 5-year survival rates following transition were 100% and 92%, respectively. There were no episodes of late rejection. In total, 66.7% of patients were compliant with immunosuppression and 61.1% of patients were compliant with clinic attendance. There was a significant relationship between medication compliance and clinic attendance, as well as presence of psychological issues with clinic non-attendance. Psychosocial outcomes were in keeping with age-matched data from the general population. All patients were employed or studying following transition. This is the first study of its kind in the Australian population, and outcomes were superior to published international data. Despite the demonstrated good outcomes, transition programs may improve healthcare engagement in this cohort.
向成人护理过渡对儿科移植受者来说是一个脆弱时期，与药物依从性降低、移植物丢失及死亡率增加相关。年轻成人期的心理社会结局在儿科移植受者与其健康同龄人之间存在差异。我们对所有通过我们中心完成过渡的儿科肝移植受者进行了一项单中心回顾性队列研究。本研究旨在评估澳大利亚一个中心儿科肝移植受者过渡后的结局，包括死亡率、依从性和心理社会发病率。过渡后的1年和5年生存率分别为100%和92%。无迟发性排斥反应事件。总体而言，66.7%的患者免疫抑制治疗依从，61.1%的患者门诊就诊依从。药物依从性与门诊就诊之间以及心理问题与未就诊之间存在显著关联。心理社会结局与来自普通人群的年龄匹配数据相符。所有患者在过渡后均就业或在学习。这是澳大利亚人群中此类的第一项研究，其结局优于已发表的国际数据。尽管已证明结局良好，但过渡项目可能会改善该队列的医疗保健参与情况。
