From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
the Transplant Services, Children's Healthcare of Atlanta, GA.
J Pediatr Gastroenterol Nutr. 2022 Nov 1;75(5):623-628. doi: 10.1097/MPG.0000000000003549. Epub 2022 Jun 27.
To analyze demographic, psychosocial, and clinical factors in pediatric liver transplant recipients for their association with death or loss to follow up in adulthood. We aimed to better understand known health disparities in transplant outcomes and identify potentially modifiable risk factors prior to transfer.
A retrospective cohort study of children who underwent liver transplantation at a large tertiary transplant center and were transferred to adult care between 2000 and 2015.
During the study period, 101 qualifying patients were transferred. Ninety-three individuals followed with an adult provider, while 8 were lost to follow up. In total 23 of 93 patients died after transfer (24.7%). Several childhood factors were associated with adult death: Black race [odds ratio (OR) 6.59, P < 0.001]; psychiatric illness or substance use (OR 2.81, P = 0.04); failure to graduate high school before transfer (OR 9.59, P < 0.001); posttransplant tacrolimus medication-level variability index >2.5 (OR 5.36, P = 0.04); provider documentation of medication nonadherence (OR 4.72, P = 0.02); acute cellular rejection (OR 4.44, P = 0.03); the presence of diabetes mellitus (OR 5.71, P = 0.001), and chronic kidney disease (OR 2.82, P = 0.04). Failure to graduate HS was associated with loss to follow up ( P < 0.001). On multivariate analysis, Black race, substance use, diabetes, and failure to graduate HS retained association with adult death (each P < 0.05).
Complex, intertwined patient characteristics are associated with increased odds of death in pediatric liver transplant recipients transferred to adult care. Early recognition of high-risk patients and intervention for modifiable factors, such as improved HS graduation and substance use prevention, may improve long-term outcomes.
分析儿科肝移植受者的人口统计学、心理社会和临床因素，以探讨其与成年后死亡或失访的关系。我们旨在更好地了解移植结局中的已知健康差异，并在转移前确定潜在的可改变的危险因素。
对 2000 年至 2015 年期间在一家大型三级移植中心接受肝移植并转至成人护理的儿童进行回顾性队列研究。
在研究期间，有 101 名符合条件的患者接受了转移。93 名患者与成人提供者一起随访，而 8 名患者失访。总共有 23 名 93 名患者在转移后死亡（24.7%）。一些儿童时期的因素与成人死亡相关：黑人种族[比值比（OR）6.59，P<0.001]；精神疾病或药物滥用（OR 2.81，P=0.04）；在转移前未能高中毕业（OR 9.59，P<0.001）；移植后他克莫司药物水平变异性指数>2.5（OR 5.36，P=0.04）；提供者记录的药物不依从（OR 4.72，P=0.02）；急性细胞排斥（OR 4.44，P=0.03）；患有糖尿病（OR 5.71，P=0.001）和慢性肾病（OR 2.82，P=0.04）。未能高中毕业与失访相关（P<0.001）。多变量分析显示，黑人种族、药物使用、糖尿病和未能高中毕业与成年后死亡相关（均 P<0.05）。
复杂的、相互交织的患者特征与转至成人护理的儿科肝移植受者死亡风险增加相关。早期识别高危患者，并干预可改变的因素，如提高高中毕业率和预防药物滥用，可能改善长期结局。
