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Abstract
BACKGROUND Graft failure risk is highest during emerging adulthood (17-24 years) in kidney and heart transplant. It is unknown whether a similar association exists in liver transplant recipients. METHODS We sought to estimate the relative hazards of graft failure at different current ages, compared with those aged 21 to 24 years. We evaluated 17 181 patients recorded in the Scientific Registry of Transplant Recipients who received a first isolated liver transplant at 40 years or younger (1988-2013) and had 6 months or longer of graft function. We used time-dependent Cox models to estimate the association between current age and failure risk, defined as retransplant or death after graft failure; observation was censored at death with graft function. RESULTS There were 2540 failures. Absolute graft failure rates were highest in ages 25 to 29 years (3.0/100 person-years). Compared with individuals with the same time since transplantation, those aged 21 to 24 years had significantly higher failure rates than those younger than 17 years and older than 34 years; hazards did not differ for those aged 25 to 29 years (1.03 [0.86, 1.24]) and were lower, but not significantly, for those aged 17 to 20 years (hazards ratio, 0.83; 95% confidence interval, 0.68-1.01) and ages 30 to 34 years (hazards ratio, 0.84; 95% confidence interval, 0.70-1.01). CONCLUSIONS Among young first isolated liver transplant recipients, graft failure risks are highest in the period from 21 to 29 years of age.
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Fredericks EM, Magee JC, Eder SJ, Sevecke JR, Dore-Stites D, Shieck V, Lopez MJ. Quality Improvement Targeting Adherence During the Transition from a Pediatric to Adult Liver Transplant Clinic. J Clin Psychol Med Settings 2016; 22:150-9. [PMID: 26231289 DOI: 10.1007/s10880-015-9427-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The transition from pediatric to adult transplant care is a high risk period for non-adherence and poor health outcomes. This article describes a quality improvement initiative integrated into a pediatric liver transplant program that focused on improving outcomes following the transfer from pediatric to adult liver transplant care. Using improvement science methodology, we evaluated the impact of our center's transition readiness skills (TRS) program by conducting a chart review of 45 pediatric liver transplant recipients who transferred to adult transplant care. Medication adherence, clinic attendance, and health status variables were examined for the year pre-transfer and first year post-transfer. 19 recipients transferred without participating in the TRS program (control group) and 26 recipients participated in the program prior to transferring to the adult clinic (TRS group). The TRS group was significantly older at the time of transfer, more adherent with medications, and more likely to attend their first adult clinic visit compared to the control group. Among the TRS group, better adolescent and parent regimen knowledge were associated with greater adherence to post-transfer clinic appointments. Transition planning should focus on the gradual shift in responsibility for health management tasks, including clinic attendance, from parent to adolescent. There may be support for extending transition support for at least 1 year post-transfer to promote adherence.
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Affiliation(s)
- Emily M Fredericks
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA.
| | - John C Magee
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - Sally J Eder
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - Jessica R Sevecke
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - Dawn Dore-Stites
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - Victoria Shieck
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - M James Lopez
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
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Foster BJ, Dahhou M, Zhang X, Dharnidharka V, Ng V, Conway J. High Risk of Graft Failure in Emerging Adult Heart Transplant Recipients. Am J Transplant 2015; 15:3185-93. [PMID: 26189336 DOI: 10.1111/ajt.13386] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 04/26/2015] [Accepted: 05/19/2015] [Indexed: 01/25/2023]
Abstract
Emerging adulthood (17-24 years) is a period of high risk for graft failure in kidney transplant. Whether a similar association exists in heart transplant recipients is unknown. We sought to estimate the relative hazards of graft failure at different current ages, compared with patients between 20 and 24 years old. We evaluated 11 473 patients recorded in the Scientific Registry of Transplant Recipients who received a first transplant at <40 years old (1988-2013) and had at least 6 months of graft function. Time-dependent Cox models were used to estimate the association between current age (time-dependent) and failure risk, adjusted for time since transplant and other potential confounders. Failure was defined as death following graft failure or retransplant; observation was censored at death with graft function. There were 2567 failures. Crude age-specific graft failure rates were highest in 21-24 year olds (4.2 per 100 person-years). Compared to individuals with the same time since transplant, 21-24 year olds had significantly higher failure rates than all other age periods except 17-20 years (HR 0.92 [95%CI 0.77, 1.09]) and 25-29 years (0.86 [0.73, 1.03]). Among young first heart transplant recipients, graft failure risks are highest in the period from 17 to 29 years of age.
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Affiliation(s)
- B J Foster
- Division of Nephrology, Department of Pediatrics, Montreal Children's Hospital, McGill University Faculty of Medicine, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - M Dahhou
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - X Zhang
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - V Dharnidharka
- Division of Nephrology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.,St. Louis Children's Hospital, St. Louis, MO
| | - V Ng
- Division of Gastroenterology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - J Conway
- Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
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He K, Shen C, Chen X, Han L, Xi Z, Zhou T, Zhang J, Xia Q. Health-related quality of life and sleep among Chinese children after living donor liver transplantation. Pediatr Transplant 2015; 19:547-54. [PMID: 26096790 DOI: 10.1111/petr.12532] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2015] [Indexed: 12/16/2022]
Abstract
LDLT is a well-established treatment for most terminal liver diseases in children. Survival rates have improved, yet few studies have considered HRQoL or sleep problems in LDLT recipients. In this cross-sectional study, we enrolled 51 children who had undergone LDLT in Renji Hospital. PedsQL(™) 4.0 Generic Core Scales, PedsQL(™) 3.0 Transplant Module, and Pediatric Sleep Questionnaire were used to assess outcomes. Of all participants, 11.8% (6/51) reported low total HRQoL scores. Participants' scores on most HRQoL subscales were comparable to the scores of healthy children. However, compared with solid organ transplant recipients, LDLT recipients scored significantly lower in About My Medicines II (t = 3.092, p = 0.002) and Worry (t = 2.760, p = 0.006). Sleep problems (41.2%) were common among participants. Hierarchical regression analyses showed that SRBD accounted for significant variance in HRQoL on total generic HRQoL (R(2) = 0.446, p < 0.001), psychosocial health (R(2) = 0.372, p = 0.001), physical health (R(2) = 0.345, p = 0.003), total transplant-specific HRQoL (R(2) = 0.514, p < 0.001), About My Medicines I (R(2) = 0.365, p = 0.013), My Transplant and Others (R(2) = 0.334, p = 0.005), Pain and Hurt (R(2) = 0.544, p < 0.001), Worry (R(2) = 0.401, p = 0.001), Treatment Anxiety (R(2) = 0.526, p < 0.001), How I Look (R(2) = 0.221, p = 0.040), and Communication (R(2) = 0.343, p = 0.012). In conclusion, sleep problems are non-negligible in children after LDLT and predicted significant variance on HRQoL.
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Affiliation(s)
- Kang He
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Conghuan Shen
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaosong Chen
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Longzhi Han
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhifeng Xi
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tao Zhou
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianjun Zhang
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiang Xia
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Venick RS. What is the future of pediatric liver transplantation? Optimal management of long-term recipients. Liver Transpl 2014; 20 Suppl 2:S19-21. [PMID: 25212753 DOI: 10.1002/lt.23994] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 09/08/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Robert S Venick
- Department of Pediatrics and Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Guercio Nuzio S, Ann Tizzard S, Vajro P. Tips and hints for the transition: What adult hepatologists should know when accept teens with a pediatric hepatobiliary disease. Clin Res Hepatol Gastroenterol 2014; 38:277-83. [PMID: 24768556 DOI: 10.1016/j.clinre.2014.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 03/25/2014] [Accepted: 03/28/2014] [Indexed: 02/04/2023]
Abstract
The number of children with chronic hepatobiliary disease surviving into adulthood is more and more increasing, but no established model of transition does exist in this category of patients. Here, we summarize medical problems expected at the time of their transition, and any impacts on morbidity and mortality in adulthood. Information provided would turn useful to adult hepatologists and practitioners responsible for ensuring continuity of care for young adults affected by diseases they are not usually accustomed to.
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Affiliation(s)
- Salvatore Guercio Nuzio
- Pediatrics Fellowship Program, Department of Health Sciences, Università del Piemonte Orientale "Amedeo Avogadro", Novara, Italy
| | - Sarah Ann Tizzard
- Paediatric Gastrointestinal, Liver and Nutrition Centre, King's College Hospital, NHS Foundation Trust, London, United Kingdom
| | - Pietro Vajro
- Chair of Paediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Salerno, Italy.
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