General Surgery 2U-Liver Transplant Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Ospedale Molinette, Corso Bramante 88-90, 10126, Turin, Italy.
Pediatric Nephrology Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Ospedale Infantile Regina Margherita, Turin, Italy.
Updates Surg. 2023 Sep;75(6):1549-1557. doi: 10.1007/s13304-023-01608-2. Epub 2023 Aug 3.
Pediatric liver transplantation is a challenging surgical procedure requiring complex post-transplant patient management. Liver transplantation in children should ensure long-term survival and good health-related quality of life (HR-QOL), but data in the literature are conflicting. With the aim of investigating survival and psychosocial outcomes of patients transplanted during childhood, we identified 40 patients with ≥ 20-year follow-up after liver transplantation regularly followed up at our Institution. Clinical charts were reviewed to retrieve patients' data. Psychosocial aspects and HR-QOL were investigated by an in-person or telephonic interview and by administering the WHOQOL-BREF questionnaire through an online form. Ten- and 20-year patient survival was 97.5% (95% CI 92.8-100%), whereas 10- and 20-year graft survival was 77.5% (65.6-91.6%) and 74.8% (62.5-89.6%), respectively. At last follow-up visit, 31 patients (77.5%) were receiving a tacrolimus-based immunosuppression. Twelve (32.4%) patients obtained a university diploma or higher, whereas 19 (51.4%) successfully completed high school. 81.1% of patients were active workers or in education, 17.5% had children, and 35% regularly practiced sport. 25 patients answered to the WHOQOL-BREF questionnaire. More than 60% of respondents did not report any disability and the perceived physical status was invariably good or very good. Median scores for physical health, psychological health, social relationships, and environment were 16.6, 14.7, 16, and 15, respectively. Pediatric liver transplantation is associated with excellent long-term survival and good HR-QOL. Psychological health and environment represent areas in which support would be needed to further improve HR-QOL.
儿童肝移植是一项具有挑战性的手术，需要对移植后的患者进行复杂的管理。儿童肝移植应确保长期生存和良好的健康相关生活质量（HR-QOL），但文献中的数据存在矛盾。为了调查儿童期接受肝移植患者的生存和心理社会结局，我们确定了在我院定期随访且随访时间≥20 年的 40 例患者。我们回顾了临床病历以获取患者数据。通过面对面或电话访谈以及通过在线表格提交 WHOQOL-BREF 问卷来调查心理社会方面和 HR-QOL。10 年和 20 年患者生存率分别为 97.5%（95%CI 92.8-100%）和 77.5%（65.6-91.6%）和 74.8%（62.5-89.6%），10 年和 20 年移植物生存率分别为 77.5%（65.6-91.6%）和 74.8%（62.5-89.6%）。最后一次随访时，31 例患者（77.5%）接受他克莫司为基础的免疫抑制治疗。12 例（32.4%）患者获得大学文凭或更高学历，19 例（51.4%）成功完成高中教育。81.1%的患者为在职人员或正在接受教育，17.5%的患者有子女，35%的患者定期参加体育运动。25 例患者回答了 WHOQOL-BREF 问卷。超过 60%的受访者没有报告任何残疾，且他们自我感知的身体状况始终良好或非常好。生理健康、心理健康、社会关系和环境的中位数评分分别为 16.6、14.7、16 和 15。儿童肝移植与长期生存和良好的 HR-QOL 相关。心理健康和环境是需要进一步改善 HR-QOL 的领域。
