Columbia University College of Physicians and Surgeons.
Department of Pediatrics, Columbia University Irving Medical Center.
J Pediatr Gastroenterol Nutr. 2020 Feb;70(2):183-189. doi: 10.1097/MPG.0000000000002553.
Improved outcomes after pediatric liver transplantation (LT) have led to increasing numbers of adolescent and young adult recipients entering into adult health care systems. The aim of this study was to evaluate the impact of transition from pediatric to adult health care models on medical outcomes, measures of adherence, and health care utilization for pediatric LT recipients.
We evaluated the course of patients who received an LT while followed in pediatrics and transferred to an adult care provider within our institution. Data were collected from 2 years preceding and 2 years following transfer of care.
A total of 32 patients were eligible for analysis. Median age at time of transfer was 22.9 years (interquartile range 21.7-23.6). Nine patients (28%) died following transfer of care. There was a significant decrease in office visit adherence following transfer of care (P = 0.02). Although not achieving significance, an increase in alanine aminotransferase values, episodes of acute cellular rejection, progression to cirrhosis, evolution to chronic rejection, and hospital admission rates post transfer were found. These findings were associated with an increase in health care costs related to required interventions.
Our study demonstrates trends toward worse health outcomes, decreased adherence, and increased health care utilization following transfer of care. These findings and poor patient survival suggest that the time around transition from pediatric to adult health care models represents a period of increased vulnerability for pediatric LT recipients. Larger, multicenter, prospective studies are needed to identify factors and interventions that affect adolescent and young adult to improve the transition process.
儿科肝移植（LT）后的结果改善导致越来越多的青少年和年轻成人受者进入成人保健系统。本研究旨在评估从儿科到成人保健模式的过渡对儿科 LT 受者的医疗结果、遵医嘱程度和保健利用的影响。
我们评估了在我们机构接受 LT 治疗并转至成人护理提供者的儿科受者的病程。数据收集于转归前 2 年和转归后 2 年。
共有 32 例患者符合分析条件。转归时的中位年龄为 22.9 岁（四分位距 21.7-23.6）。9 例患者（28%）在转归后死亡。转归后门诊就诊遵医嘱程度显著下降（P=0.02）。尽管未达到统计学意义，但转归后丙氨酸氨基转移酶值升高、急性细胞排斥反应发作、进展为肝硬化、演变为慢性排斥反应和住院率增加的趋势。这些发现与需要干预的相关保健费用增加有关。
我们的研究表明，转归后健康结果恶化、遵医嘱程度下降和保健利用增加的趋势。这些发现和较差的患者生存率表明，从儿科到成人保健模式的过渡时期代表了儿科 LT 受者易受伤害的时期。需要更大规模、多中心、前瞻性研究来确定影响青少年和年轻成人的因素和干预措施，以改善过渡过程。
