儿科至成人实体器官移植受者过渡期：现有过渡方案的系统评价。

Pediatric to Adult Transition in Solid Organ Transplant Recipients: A Systematic Review of Existing Transition Programs.

机构信息

Northeast Ohio Medical University, Rootstown, Ohio, USA.

Department of Pediatrics II, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.

出版信息

Pediatr Transplant. 2024 Dec;28(8):e14896. doi: 10.1111/petr.14896.

DOI:10.1111/petr.14896

PMID:39559923

Abstract

BACKGROUND

Pediatric organ transplantation is the primary treatment for end-organ failure. Improving medication adherence and healthcare compliance can decrease healthcare burdens, graft rejection, morbidity, and mortality. Adolescents commonly struggle with non-adherence, necessitating a smooth transition to adult care. This systematic review aims to assess and evaluate the effectiveness of existing transition tools and models used in the care of pediatric solid organ transplant recipients (pSOTR).

METHODS

A systematic literature review of studies in electronic databases (PubMed, Google Scholar, and Mendeley) on interventions improving transition in pediatric solid organ transplant recipients (pSOTR) from 2000 to 2022 was conducted. Included studies involved pSOTR before the age of 12 years transitioning to adult care.

RESULTS

A lower proportion of graft acute rejection was observed among pSOTR with more than two transition interventions (10.088%, 95% CI: 0.901%-27.441%, I = 85.95%, p < 0.0001, random effects, five studies, n = 155) compared to those with two or fewer interventions (13.892%, 95% CI: 4.588%-27.142%, I = 74.73%, p = 0.0014, random effects, six studies, n = 140). Additionally, a significant association was found between transition protocols and lower rejection rates (χ = 10.57, p = 0.0011), with multiple protocols showing better outcomes (χ = 5.091, p = 0.024). Although adherence scores differed significantly with and without transition protocols (χ = 8.75, p = 0.0126), no significant difference was found between single and multiple protocol groups (χ = 4.8, p = 0.091).

CONCLUSION

This review identifies various transition models and their impact on adherence and graft rejection, which correlate with morbidity and mortality and influence transplant outcomes. The heterogeneity of data within the current literature necessitates further research to establish causality and develop a standardized transition program aimed at improving patient outcomes.

摘要

背景

儿科器官移植是治疗终末器官衰竭的主要方法。提高药物依从性和医疗保健依从性可以降低医疗负担、移植物排斥、发病率和死亡率。青少年通常难以做到遵医嘱，因此需要顺利过渡到成人护理。本系统评价旨在评估和评估用于儿科实体器官移植受者（pSOTR）护理的现有过渡工具和模型的效果。

方法

对 2000 年至 2022 年电子数据库（PubMed、Google Scholar 和 Mendeley）中关于改善儿科实体器官移植受者（pSOTR）过渡的干预措施的研究进行了系统文献回顾。纳入的研究涉及年龄在 12 岁以下的 pSOTR 过渡到成人护理。

结果

与接受两次或更少干预的 pSOTR 相比，接受两次或更多过渡干预的 pSOTR 发生移植物急性排斥的比例较低（10.088%，95%CI：0.901%-27.441%，I=85.95%，p<0.0001，随机效应，五篇研究，n=155）。此外，发现过渡方案与较低的排斥率之间存在显著关联（χ²=10.57，p=0.0011），多个方案显示出更好的结果（χ²=5.091，p=0.024）。尽管在有和没有过渡方案的情况下，依从性评分有显著差异（χ²=8.75，p=0.0126），但在单一和多个方案组之间没有发现显著差异（χ²=4.8，p=0.091）。