From the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, MO.
the Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA.
J Pediatr Gastroenterol Nutr. 2023 Oct 1;77(4):448-454. doi: 10.1097/MPG.0000000000003909. Epub 2023 Aug 7.
This study sought to understand the current monitoring practices after pediatric liver transplantation (LT), specifically regarding follow-up clinic visits, outpatient laboratory testing, protocol biopsies, and diagnostic imaging, and to identify potential center and provider characteristics associated with such practices.
A cross-sectional survey of pediatric LT providers at centers participating in the Society of Pediatric Liver Transplantation (SPLIT) registry was conducted from February 2020 to April 2021.
The overall response rate was 79% (38/48 SPLIT centers), with the majority representing large volume centers (>10 LTs per year). Frequency of clinic visits and laboratory monitoring varied by center, but all centers decreased frequency after the first post-transplant year. The most common practice included an annual clinic visit and laboratory sampling every 2-3 months. Surveillance liver biopsy is seldom done during the first post-transplant year, while being routinely performed by 50% of centers after this time period. Centers forgoing surveillance biopsies assert that the results would likely not change management. Only 39% of centers have a hepatologist perform the liver biopsy while the remaining centers consult interventional radiology. Most diagnostic imaging is obtained only as needed. Routine abdominal ultrasounds were obtained by only 50% of responding centers after the first year post-transplant.
SPLIT centers vary widely in the routine management of LTs after the first year post-transplant. While common themes emerge, future studies will be needed to connect protocols to outcomes to determine best practice.
本研究旨在了解小儿肝移植（LT）后的当前监测实践，特别是关于随访门诊就诊、门诊实验室检查、方案活检和诊断成像，并确定与这些实践相关的潜在中心和提供者特征。
对参与小儿肝移植协会（SPLIT）注册中心的小儿 LT 提供者进行了一项横断面调查，调查于 2020 年 2 月至 2021 年 4 月进行。
总体应答率为 79%（48 个 SPLIT 中心中的 38 个），大多数代表大体积中心（每年>10 例 LT）。就诊和实验室监测的频率因中心而异，但所有中心在移植后第一年都会降低频率。最常见的做法包括每年进行一次门诊就诊和每 2-3 个月进行一次实验室采样。在移植后的第一年很少进行监测性肝活检，而在此期间 50%的中心常规进行。放弃监测活检的中心认为结果不太可能改变治疗方案。只有 39%的中心由肝科医生进行肝活检，其余中心则咨询介入放射科。大多数诊断成像仅在需要时进行。只有 50%的应答中心在移植后第一年进行常规腹部超声检查。
SPLIT 中心在移植后第一年的 LT 常规管理中差异很大。虽然出现了一些共同主题，但仍需要进一步的研究将方案与结果联系起来，以确定最佳实践。
