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Contrast-enhanced ultrasound of transplant organs - liver and kidney - in children. Pediatr Radiol 2021; 51:2284-2302. [PMID: 33978794 PMCID: PMC8865443 DOI: 10.1007/s00247-020-04867-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/13/2020] [Accepted: 09/30/2020] [Indexed: 10/21/2022]
Abstract
Ultrasound (US) is the first-line imaging tool for evaluating liver and kidney transplants during and after the surgical procedures. In most patients after organ transplantation, gray-scale US coupled with color/power and spectral Doppler techniques is used to evaluate the transplant organs, assess the patency of vascular structures, and identify potential complications. In technically difficult or inconclusive cases, however, contrast-enhanced ultrasound (CEUS) can provide prompt and accurate diagnostic information that is essential for management decisions. CEUS is indicated to evaluate for vascular complications including vascular stenosis or thrombosis, active bleeding, pseudoaneurysms and arteriovenous fistulas. Parenchymal indications for CEUS include evaluation for perfusion defects and focal inflammatory and non-inflammatory lesions. When transplant rejection is suspected, CEUS can assist with prompt intervention by excluding potential underlying causes for organ dysfunction. Intracavitary CEUS applications can evaluate the biliary tract of a liver transplant (e.g., for biliary strictures, bile leak or intraductal stones) or the urinary tract of a renal transplant (e.g., for urinary obstruction, urine leak or vesicoureteral reflux) as well as the position and patency of hepatic, biliary and renal drains and catheters. The aim of this review is to present current experience regarding the use of CEUS to evaluate liver and renal transplants, focusing on the examination technique and interpretation of the main imaging findings, predominantly those related to vascular complications.
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Hoegy D, Bleyzac N, Robinson P, Bertrand Y, Dussart C, Janoly-Dumenil A. Medication adherence in pediatric transplantation and assessment methods: a systematic review. Patient Prefer Adherence 2019; 13:705-719. [PMID: 31123396 PMCID: PMC6511245 DOI: 10.2147/ppa.s200209] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/01/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Medication adherence is a major concern in public health. It is fully established that immunosuppressive therapy (IT) and concomitant medications affect transplant outcomes in the pediatric population, showing interest in adherence to this therapy. The aim of the present review was to report on medication adherence in pediatric population post-transplantation. This will enable us to know the situation in this particular population. Methods: A literature search was performed using the MEDLINE database. Studies that were published from January 1999 to January 2016 in English language and which investigated medication adherence in pediatric transplantation were included. The type of organ and the methods used to assess medication adherence were studied. Results: A total of 281 records were identified, from which 34 studies were selected: 38% (n=13) on kidney transplantation, 32% (n=11) on liver transplantation, and 23% (n=10) on the transplantation of other organs. Medication adherence was found to be lower than 80% in two-thirds of the studies (64%), and varied from 22% to 97%. This wide range was explained in part by the important heterogeneity of assessment methods among studies. The methods used were objective, non-objective, or combined both types. Most studies did not fully describe the data collected: the time since transplantation, the period over which adherence was assessed, the population, the medications, and the threshold discriminating adherence and non-adherence. Conclusion: The present study found poor medication adherence in the pediatric population post-transplantation. There was a wide range of medication adherence, explained largely by the heterogeneity of assessment methods. Future studies must consider the characteristics of each methodology, but also the threshold defining adherence should be chosen on the basis of clinical outcomes, and describe all data collected to gain precision. To improve adherence in this population, it is essential to identify factors influencing medication (IT and concomitant medications) adherence.
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Affiliation(s)
- Delphine Hoegy
- EA 4129 P2S Parcours Santé Systémique – Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
- Pharmacy, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Correspondence: Delphine HoegyP2S, EA 4129, universités Lyon I & III, 5 place d’Arsonval, 69003, Lyon, FranceEmail
| | - Nathalie Bleyzac
- Institut d’Hématologie et d’Oncologie Pédiatrique, Hospices Civils de Lyon, Lyon, France
- EMR 3738, PK/PD Modeling in Oncology, université Lyon-Sud, Lyon, France
| | - Philip Robinson
- Direction de la Recherche Clinique et de l’Innovation, Hospices Civils de Lyon, Lyon, France
| | - Yves Bertrand
- Institut d’Hématologie et d’Oncologie Pédiatrique, Hospices Civils de Lyon, Lyon, France
- U1111-CNRS UMR 5308, University of Lyon I, ENS Lyon, Lyon, France
| | - Claude Dussart
- EA 4129 P2S Parcours Santé Systémique – Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
- Central Pharmacy, Hospices Civils de Lyon, Lyon, France
| | - Audrey Janoly-Dumenil
- EA 4129 P2S Parcours Santé Systémique – Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
- Pharmacy, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
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Akın Sarı B, Baskın SE, Özçay F, Sezgin A, Haberal M. Psychiatric Evaluation of Children During the Organ Transplant Process. EXP CLIN TRANSPLANT 2018. [PMID: 29633927 DOI: 10.6002/ect.2017.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Organ transplantation is performed frequently in Turkey. A routine psychiatric examination is performed before all transplant procedures, and psychiatric support is continued during the posttransplant period. In this study, we reviewed the psychiatric consultation records of child and adolescent patients admitted to Başkent University Hospital who underwent or were scheduled to undergo transplant to determine the prevalence of psychiatric disorders in this population. MATERIALS AND METHODS Fifty-nine transplant patients were seen by the Department of Child and Adolescent Psychiatry between 2012 and 2015 and were evaluated based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. RESULTS Thirty patients (50.8%) were female, and 29 patients (49.2%) were male. The mean age of the study population was 10.2 ± 4.5 years, and the mean age at transplant was 9.9 ± 4.6 years. In total, 69.5% of participants were diagnosed with a psychiatric disorder. The most common diagnosis was adjustment disorder, with a prevalence of 52.4%. CONCLUSIONS Our study found that psychiatric disorders are frequently encountered in pediatric transplant patients. This study revealed a higher prevalence of psychiatric disorders during the posttransplant period than during the pretransplant period.
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Affiliation(s)
- Burcu Akın Sarı
- From the Department of Child and Adolescent Psychiatry, Faculty of Medicine, Başkent University, Ankara, Turkey
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Abstract
Liver transplantation originated in children more than 50 years ago, and these youngest patients, while comprising the minority of liver transplant recipients nationwide, can have some of the best and most rewarding outcomes. The indications for liver transplantation in children are generally more diverse than those seen in adult patients. This diversity in underlying cause of disease brings with it increased complexity for all who care for these patients. Children, still being completely dependent on others for survival, also require a care team that is able and ready to work with parents and family in addition to the patient at the center of the process. In this review, we aim to discuss diagnoses of particular uniqueness or importance to pediatric liver transplantation. We also discuss the evaluation of a pediatric patient for liver transplant, the system for allocating them a new liver, and also touch on postoperative concerns that are unique to the pediatric population.
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Squires RH, Ng V, Romero R, Ekong U, Hardikar W, Emre S, Mazariegos GV. Evaluation of the pediatric patient for liver transplantation: 2014 practice guideline by the American Association for the Study of Liver Diseases, American Society of Transplantation and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Hepatology 2014; 60:362-98. [PMID: 24782219 DOI: 10.1002/hep.27191] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 04/22/2014] [Indexed: 12/16/2022]
Affiliation(s)
- Robert H Squires
- Department of Pediatrics, University of Pittsburgh School of Medicine; Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
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Shah UH, Wadhwa N, Sharma D, Jerath N, Wadhawan M, Vij V, Goyal N, Sibal A, Gupta S. Current Status of Pediatric Liver Transplantation in India. APOLLO MEDICINE 2008. [DOI: 10.1016/s0976-0016(11)60157-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Finegold MJ, Egler RA, Goss JA, Guillerman RP, Karpen SJ, Krishnamurthy R, O'Mahony CA. Liver tumors: pediatric population. Liver Transpl 2008; 14:1545-56. [PMID: 18975283 DOI: 10.1002/lt.21654] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Liver tumors in childhood are rare and are typically not detected clinically until they reach a large size and often spread within the organ or metastasize. This can make surgical resection problematic, and almost all of them require extirpation for cure. With very effective chemotherapy for hepatoblastoma and to some extent for sarcomas, many cancers can be shrunk to permit partial hepatectomy, but for most hepatocarcinomas, some of the other malignancies, and even some benign proliferations, their location at the hilum and multiplicity of masses in multiple lobes make transplantation the treatment of choice. Major advances in diagnostic imaging, especially enhanced computed tomography and magnetic resonance imaging, permit a preoperative choice of resection versus transplantation to be achieved in almost all instances, and for the remainder, intraoperative ultrasonography can further help to determine the most desirable approach. The outcome is very much better in the case of hepatoblastoma when transplantation is a primary modality rather than following unsuccessful attempts at resection. In this review, transplantation for liver tumors in children is considered from all aspects, including the importance of screening for tumors whenever possible to avoid the need for transplantation.
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