Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Texas Southwestern, Dallas, Texas, USA.
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Toronto.
Curr Opin Pediatr. 2019 Oct;31(5):636-644. doi: 10.1097/MOP.0000000000000809.
Long-term survival is now the rule rather than the exception for infants and children who undergo liver transplantation for end-stage liver disease, metabolic liver conditions and a variety of other indications. Pediatricians and primary care providers play vital roles in the care and management of this patient population. The purpose of this review is to highlight key aspects important to the care of the pediatric liver transplant recipient.
Significant advances in immunosuppressive therapies and surgical techniques have contributed to improved graft and patient survival rates, shifting the focus beyond immediate survival to strategies to minimize comorbidities related to long-term immunosuppression during growing years, attend to patient and parent-reported outcomes and enhance quality of life. A multidisciplinary approach allows for monitoring and surveillance of both routine (growth, nutritional rehabilitation, cognitive development, mental and psychosocial health, contraception and daily activities) and transplant-related (adverse effects of immunosuppression, susceptible infections, extra-hepatic systems, transition from childhood to adolescence to adulthood) themes.
Effective communication between the primary care physician and the transplant team is imperative for optimizing best outcomes. The primary care provider should be aware of the multifacet nature of posttransplant management, which includes medication regimens, common complications and infections.
对于因终末期肝病、代谢性肝病和各种其他适应证而接受肝移植的婴儿和儿童，长期生存现在是常规，而非例外。儿科医生和初级保健提供者在该患者群体的护理和管理中发挥着至关重要的作用。本综述的目的是强调与儿科肝移植受者护理相关的关键方面。
免疫抑制治疗和外科技术的显著进步促进了移植物和患者生存率的提高，关注重点已从即刻生存转移到了制定策略以尽量减少生长期间长期免疫抑制相关的合并症，关注患者和家长报告的结果，并提高生活质量。多学科方法可用于监测和随访常规（生长、营养康复、认知发展、精神和心理健康、避孕和日常活动）和移植相关主题（免疫抑制的不良反应、易感染、肝外系统、从儿童期到青春期到成年期的过渡）。
初级保健医生和移植团队之间进行有效的沟通对于优化最佳结果至关重要。初级保健提供者应了解移植后管理的多方面性质，包括药物治疗方案、常见并发症和感染。
