Ng Vicky Lee, Mazariegos George V, Kelly Beau, Horslen Simon, McDiarmid Sue V, Magee John C, Loomes Kathleen M, Fischer Ryan T, Sundaram Shikha S, Lai Jennifer C, Te Helen S, Bucuvalas John C
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Transplant and Regenerative Medicine Center, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.
Pediatr Transplant. 2019 Sep;23(6):e13537. doi: 10.1111/petr.13537. Epub 2019 Jul 25.
Long-term survival for children who undergo LT is now the rule rather than the exception. However, a focus on the outcome of patient or graft survival rates alone provides an incomplete and limited view of life for patients who undergo LT as an infant, child, or teen. The paradigm has now appropriately shifted to opportunities focused on our overarching goals of "surviving and thriving" with long-term allograft health, freedom of complications from long-term immunosuppression, self-reported well-being, and global functional health. Experts within the liver transplant community highlight clinical gaps and potential barriers at each of the pretransplant, intra-operative, early-, medium-, and long-term post-transplant stages toward these broader mandates. Strategies including clinical research, innovation, and quality improvement targeting both traditional as well as PRO are outlined and, if successfully leveraged and conducted, would improve outcomes for recipients of pediatric LT.
对于接受肝移植（LT）的儿童来说，长期存活如今已成为常态而非例外。然而，仅关注患者或移植物存活率的结果，对于那些在婴儿期、儿童期或青少年期接受肝移植的患者而言，提供的是对其生活不完整且有限的看法。现在，范例已适当地转向关注我们的总体目标“生存与茁壮成长”的机会，包括长期移植物健康、长期免疫抑制无并发症、自我报告的幸福感以及整体功能健康。肝移植领域的专家强调了在移植前、术中、移植后早期、中期和长期的各个阶段，朝着这些更广泛的任务存在的临床差距和潜在障碍。针对传统指标以及患者报告结局（PRO）的包括临床研究、创新和质量改进在内的策略已被概述，并且如果成功利用和实施，将改善小儿肝移植受者的结局。
