Department of Pediatrics, Division of Gastronterology, Hepatology and Nutrition, Emory University School of Medicine, Atlanta, GA, USA.
Transplant Services, Children's Healthcare of Atlanta, Atlanta, GA, USA.
Curr Gastroenterol Rep. 2021 Jan 29;23(3):3. doi: 10.1007/s11894-020-00802-1.
Many pediatric liver transplant patients are surviving to adulthood, and providers have come to recognize the importance of effectively transitioning these patients to an adult hepatologist. The review aims to analyze the most recent literature regarding patient outcomes after transition, barriers to successful transition, recommendations from clinicians and medical societies regarding transition programs, and to provide personal insights from our experience in transitioning liver transplant recipients.
While results were variable between studies, many recent reports show significant morbidity and mortality in patients following transition to adult care. Medical non-adherence is frequently seen in adolescents and young adults both prior to and after transition, and is consistently associated with higher rates of rejection, graft loss, and death. In general, transplant programs with a formal transition process had better patient outcomes though recent findings are mostly-single center and direct comparison between programs is difficult. Societal recommendations for how to create a transition program contain a number of common themes that we have categorized for easier understanding. Successful transition is vital to the continued health of pediatric liver transplant patients. While an effective transition program includes a number of key components, it should be individualized to best function within a given transplant center. Here, we have reviewed a number of recent single-center retrospective studies on transition, but multi-site retrospective or prospective data is lacking, and is a fertile area for future research.
许多儿科肝移植患者已存活至成年，临床医生逐渐认识到有效地将这些患者过渡到成人肝病专家手中的重要性。本文旨在分析最近关于患者过渡后结局、过渡成功障碍、临床医生和医学协会关于过渡计划的建议的文献，并提供我们在肝移植受者过渡方面的经验见解。
尽管研究间结果存在差异，但许多最近的报告显示，患者在过渡到成人护理后存在显著的发病率和死亡率。在过渡前后，青少年和年轻人经常出现医疗不依从，且与更高的排斥反应、移植物丢失和死亡发生率一致。一般来说，具有正式过渡流程的移植项目患者结局更好，但最近的研究结果主要是单中心的，并且难以在项目之间进行直接比较。关于如何创建过渡项目的社会建议包含许多共同主题，我们对其进行了分类以方便理解。成功过渡对儿科肝移植患者的持续健康至关重要。虽然有效的过渡计划包括许多关键组成部分，但它应该根据特定移植中心的情况进行个性化调整。在这里，我们回顾了一些最近的关于过渡的单中心回顾性研究，但缺乏多中心回顾性或前瞻性数据，这是未来研究的一个富有成果的领域。
