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Re-Arterialized Rat Partial Liver Transplantation with an in vivo Vessel-Oriented 70% Hepatectomy
Published on: April 8, 2018
Changing definitions of successful outcomes in pediatric liver transplantation
Nanda Kerkar1, Tanaz Danialifar
1aKeck School of Medicine, University of Southern California bDivision of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Los Angeles, University of Southern California, Los Angeles, California, USA.
Insights
Pediatric transplantation success now focuses on long-term survival and quality of life. Advances enable more children to reach adulthood, but medical and psychosocial interventions are crucial for a normal life post-transplant.
Area of Science:
- Pediatric transplantation
- Immunology
- Transplant medicine
Background:
- Pediatric transplantation has evolved from focusing on short-term survival to emphasizing long-term patient and graft survival.
- Achieving a 'normal' life post-transplantation is a key goal, encompassing physical, cognitive, and psychosocial well-being.
Purpose of the Study:
- To review the multifaceted aspects of pediatric transplantation that impact long-term outcomes and quality of life.
- To highlight the importance of medical and psychosocial interventions for pediatric transplant recipients.
Main Methods:
- This is a review article, synthesizing current knowledge and recent findings in pediatric transplantation.
- The review discusses advances in surgical techniques, organ allocation, post-operative care, immunosuppression, and psychosocial support.
Main Results:
- Advances in medical and surgical care have improved long-term survival, enabling more pediatric liver transplant recipients to reach adulthood.
- Key factors for achieving 'normality' include optimizing growth and puberty, managing immunosuppression side effects, and addressing cognitive development.
- Adolescent transplant recipients require special attention, particularly regarding adherence to medical regimens and the transition to adult care.
Conclusions:
- Addressing various medical and psychosocial issues in pediatric transplantation is essential for improving recipients' quality of life.
- Successful transition from pediatric to adult healthcare services is critical for sustained long-term outcomes.
- Achieving operational tolerance remains an ongoing goal in transplantation research.
Purpose Of Review:
This review highlights the fact that in the current era, the focus of success in pediatric transplantation has moved from short-term to long-term patient and graft survival as well as achieving 'normality' after transplantation.
Recent Findings:
Advances in surgical techniques, organ allocation, intensive care management, laboratory tests, interventional and diagnostic radiology, immunosuppressive, and antiviral drugs have allowed a larger number of pediatric liver transplant recipients to progress into adulthood. To achieve 'normality' several medical and psychosocial factors have become the target of intervention. Attaining optimal linear growth and puberty after transplant is important as is minimizing adverse events associated with immunosuppression. Special considerations are important in the adolescent transplant recipient, particularly adherence to medical recommendations. Liver transplant recipients have been reported to have below average intelligence quotient at school entry and significantly lower health-related quality of life than healthy controls and appropriate interventions need to be put in place early. Successful long-term outcomes in transplantation are contingent on successful transition from pediatric to adult healthcare services. Achieving operational tolerance remains a goal.
Summary:
In conclusion, this review outlines the myriad issues around pediatric transplantation that can be addressed so that the transplant recipient may experience a 'normal' quality of life.
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