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Pediatric Living-Donor Liver Transplant Recipients without Transition After Reaching Adulthood

Chikashi Nakanishi1, Shigehito Miyagi1, Kazuaki Tokodai1

  • 1Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.

Annals of Transplantation
|January 9, 2019
PubMed

Insights

Pediatric liver transplant recipients cared for by the same team into adulthood show excellent survival rates. This integrated care model appears beneficial for long-term outcomes in young adults post-transplant.

Area of Science:

  • Hepatology
  • Transplant Surgery
  • Pediatric Gastroenterology

Background:

  • Transitioning pediatric liver transplant recipients to adult care can present challenges.
  • Integrated care models, where the same team manages both pediatric and adult liver transplant patients, are utilized at some institutions.
  • The impact of this integrated care system on pediatric liver transplant recipient outcomes during the transition to adulthood remains unclear.

Purpose of the Study:

  • To retrospectively assess the outcomes of pediatric liver transplant recipients who reached adulthood under the care of a single, integrated transplant team.
  • To evaluate the long-term survival, complications, and adherence in this patient cohort.

Main Methods:

  • Single-center, retrospective study of consecutive pediatric living-donor liver transplant recipients reaching age 18 by October 2017.
  • Inclusion of 36 recipients (20 female, 16 male).
  • Analysis of patient survival, incidence of biliary strictures, graft rejection, compliance, and psychiatric diagnoses post-transition.

Main Results:

  • Excellent 5-year (100%) and 10-year (93%) patient survival after age 18.
  • Biliary strictures were the primary cause of mortality; 13.9% experienced symptomatic strictures or recurrence post-18.
  • Low rates of noncompliance (11.1%) and psychiatric diagnoses (13.9%) were observed, with no significant association between compliance and outcomes.

Conclusions:

  • Pediatric liver transplant recipients managed by an integrated adult and pediatric care team demonstrate favorable long-term outcomes.
  • Continuous care by the same transplant team may mitigate transition-related challenges and improve survival for young adult liver transplant recipients.
  • The findings support the benefit of a unified care approach for pediatric liver transplant survivors transitioning to adulthood.

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