Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy.
Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Children with Liver Transplant, Department of Women and Children's Health, Padua University Hospital, Padua, Italy.
Liver Int. 2018 Jul;38(7):1316-1321. doi: 10.1111/liv.13655. Epub 2018 Jan 8.
BACKGROUND & AIMS: Survival rates after liver transplantation (LT) in paediatric recipients have significantly improved over time. However, data regarding outcomes after transition from Paediatric to Adult Healthcare Service (AHS) are still lacking. Therefore, we aimed to prospectively evaluate the outcome of LT recipients after transition, to access patients' non-adherence and identify potential risk factors for non-adherence.
All consecutive adolescent LT recipients moving to the AHS at Padua University Hospital were evaluated between 2010 and 2015. Demographic data, liver function tests, incidence of acute or chronic rejection episodes and adherence to medical prescription, were prospectively evaluated. An educational pilot study was implemented since 2015 to foster adherence during transition.
In all, 32 patients (M/F 16/16, median age: 23 years) were evaluated. Median interval time between LT and transition was 15 years (range: 1-26 years). The main indication for LT was biliary atresia (31%), whereas immunosuppression regimen was tacrolimus-based in 75%. After a median follow-up of 29 months (range: 12-83), no significant modifications of liver function tests were observed. Biopsy-proven chronic rejection was diagnosed in 6/32 (18%) of patients, who had higher standard deviation of tacrolimus trough level than patients without (1.5 vs 1, P = .03). Non-adherence was reported in 8/32 (25%) of patients and was significantly associated with alcohol consumption (P = .003). Patient and graft survival were 96% and 93%, respectively.
Adolescent LT patients who undergo transition to the AHS have good long-term outcomes. However, a multidisciplinary approach aiming at fostering adherence should be used.
随着时间的推移，儿童肝移植（LT）受者的存活率显著提高。然而，关于从儿科医疗服务（AHS）过渡到成人医疗服务后结果的数据仍然缺乏。因此，我们旨在前瞻性评估 LT 受者过渡后的结果，评估患者的不依从性并确定不依从的潜在危险因素。
2010 年至 2015 年期间，评估了所有在帕多瓦大学医院转至 AHS 的青少年 LT 受者。前瞻性评估了人口统计学数据、肝功能检查、急性或慢性排斥反应的发生率以及对医嘱的依从性。自 2015 年以来，实施了一项教育试点研究，以促进过渡期间的依从性。
共评估了 32 名患者（男/女 16/16，中位年龄：23 岁）。LT 与过渡之间的中位时间间隔为 15 年（范围：1-26 年）。LT 的主要适应证是胆道闭锁（31%），而免疫抑制方案是他克莫司为基础的方案，占 75%。中位随访 29 个月（范围：12-83 个月）后，肝功能检查未见明显变化。6/32（18%）的患者经活检证实为慢性排斥反应，其他克莫司谷浓度标准差高于无慢性排斥反应的患者（1.5 比 1，P=.03）。8/32（25%）的患者报告不依从，且与饮酒显著相关（P=.003）。患者和移植物存活率分别为 96%和 93%。
转至 AHS 的青少年 LT 受者具有良好的长期结果。然而，应该采用多学科方法来促进依从性。
