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Laborde N, Barange K, Girard C, Marbach C, Bureau C, Broué P. Transition care to adolescent hepatology in a tertiary center for rare adult-child liver disease. Arch Pediatr 2024; 31:32-37. [PMID: 37989665 DOI: 10.1016/j.arcped.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/10/2023] [Accepted: 08/22/2023] [Indexed: 11/23/2023]
Abstract
AIMS This study analyzed the results of a transition program in a patient population with a rare liver disease of pediatric onset. METHOD Data were collected on the clinical course of an adolescent population with a rare disease of pediatric onset and enrolled in a transition program between 1994 and 2022. RESULTS A total of 238 adolescents (including 34 having undergone a liver transplant on enrolling in the program) were included. Eight patients were lost to follow-up before the first transition consultation and 16 families requested follow-up in an adult hepatology department closer to their home. Overall, 214 initial transition consultations were carried out; 29 patients were subsequently lost to follow-up and 13 switched center. Overall, 15.4 % of the patients enrolled in our program were lost to follow-up. Five adult patients underwent a liver transplantation during this 28-year period. Overall mortality was 3.2 %, graft survival was 91.5 %, and posttransplant survival was 92 %. In total, the current active file represents 183 patients with a median age of 24.3 years (18-51) and a median follow-up period of 5.8 years (6 months to 28 years). CONCLUSION The implementation of a transition program to adult medicine for adolescents with a rare liver disease should follow the recommendations but must be adapted in line with local practice conditions. This process requires close collaboration between the pediatric and adult medicine teams based on a mutual desire to constantly improve practices and enhance knowledge.
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Affiliation(s)
- Nolwenn Laborde
- Pediatric Hepatology and Hereditary Metabolism Disorders. Hôpital des Enfants [Children's Hospital]-CHU Toulouse [Toulouse University Hospital] France.
| | - Karl Barange
- Service d'hépatologie [Hepatology Department], Hôpital de Rangueil [Rangueil Hospital], CHU Toulouse [Toulouse University Hospital] France
| | - Chloé Girard
- Pediatric Hepatology and Hereditary Metabolism Disorders. Hôpital des Enfants [Children's Hospital]-CHU Toulouse [Toulouse University Hospital] France
| | - Clothilde Marbach
- Pediatric Hepatology and Hereditary Metabolism Disorders. Hôpital des Enfants [Children's Hospital]-CHU Toulouse [Toulouse University Hospital] France
| | - Christophe Bureau
- Service d'hépatologie [Hepatology Department], Hôpital de Rangueil [Rangueil Hospital], CHU Toulouse [Toulouse University Hospital] France
| | - Pierre Broué
- Pediatric Hepatology and Hereditary Metabolism Disorders. Hôpital des Enfants [Children's Hospital]-CHU Toulouse [Toulouse University Hospital] France
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Optimization of the transition process of youth with liver disease in adulthood: A position paper from FILFOIE, the French network for paediatric and adult rare liver diseases. Clin Res Hepatol Gastroenterol 2020; 44:135-141. [PMID: 31564624 DOI: 10.1016/j.clinre.2019.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 02/04/2023]
Abstract
Transition describes a progressive and highly coordinated process encompassing the transfer of a young patient from paediatric care to the adult-care system. Transfer of medical care for an adolescent to adult services is a complex and challenging task requiring close collaboration of both the paediatric and adult-care providers. It must take into account the medical, psychosocial and educational needs of the young adult. The Transition Working Group of the French Network for Rare Liver Diseases (FILFOIE) proposes recommendations and tools designed to optimise the transition process of adolescents and young adults with chronic liver disease from child-based to adult-based healthcare services, focusing on three key time points: preparation before the transfer, the transfer process to the adult service, and finally reception and follow-up within the adult-care service.
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The Health Care Transition of Youth With Liver Disease Into the Adult Health System: Position Paper From ESPGHAN and EASL. J Pediatr Gastroenterol Nutr 2018; 66:976-990. [PMID: 29570559 DOI: 10.1097/mpg.0000000000001965] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Medical advances have dramatically improved the long-term prognosis of children and adolescents with once-fatal hepatobiliary diseases. However, there is no generally accepted optimal pathway of care for the transition from paediatric care to the adult health system. AIM The purpose of this position paper is to propose a transition process for young people with paediatric onset hepatobiliary diseases from child-centred to adult-centred healthcare services. METHODS Seventeen ESPGHAN/EASL physicians from 13 countries (Austria, Belgium, France, Germany, Hungary, Italy, the Netherlands, Norway, Poland, Spain, Sweden, Switzerland, and United Kingdom) formulated and answered questions after examining the currently published literature on transition from childhood to adulthood. PubMed and Google Scholar were systematically searched between 1980 and January 2018. Quality of evidence was assessed by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) system. Expert opinions were used to support recommendations whenever the evidence was graded weak. All authors voted on each recommendation, using the nominal voting technique. RESULTS We reviewed the literature regarding the optimal timing for the initiation of the transition process and the transfer of the patient to adult services, principal documents, transition multi-professional team components, main barriers, and goals of the general transition process. A transition plan based on available evidence was agreed focusing on the individual young people's readiness and on coordinated teamwork, with transition monitoring continuing until the first year of adult services.We further agreed on selected features of transitioning processes inherent to the most frequent paediatric-onset hepatobiliary diseases. The discussion highlights specific clinical issues that will probably present to adult gastrointestinal specialists and that should be considered, according to published evidence, in the long-term tracking of patients. CONCLUSIONS Transfer of medical care of individuals with paediatric onset hepatobiliary chronic diseases to adult facilities is a complex task requiring multiple involvements of patients and both paediatric and adult care providers.
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Nutrition and Liver Disease. Nutrients 2017; 10:nu10010009. [PMID: 29295475 PMCID: PMC5793237 DOI: 10.3390/nu10010009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 12/13/2022] Open
Abstract
Malnutrition in children and adults with advanced liver disease represents a tremendous challenge as the nutritional problems are multifactorial. This Editorial comments the articles appearing in this special issue of Nutrients, “Nutrition and Liver disease” dealing with multiple diagnostic and therapeutic features that relate the outcomes of liver disease to nutrition. To improve quality of life and prevent nutrition-related medical complications, patients diagnosed with advanced liver disease should have their nutritional status promptly assessed and be supported by appropriate dietary interventions. Furthermore specific food supplements and/or restriction diets are often necessary for those with hepatic conditions associated with an underlying metabolic or nutritional or intestinal disease.
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Soeda E, Hoshino K, Izawa Y, Takaoka C, Isobe C, Takahashi A, Takahashi N, Yamada Y, Shimojima N, Fujino A, Shinoda M, Kitagawa Y, Tanabe M, Nakamaru S, Taki N, Sekiguchi A, Nakazawa Y, Turukawa T, Kuroda T. A Report on the Positive Response to an Outdoor Nature Challenge of a Snow Camp for Young Liver Transplant Patients. Transplant Proc 2017; 49:115-120. [PMID: 28104117 DOI: 10.1016/j.transproceed.2016.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES More than two decades have passed since the first living donor liver transplantation was performed in Japan in 1989. There are many reports about problems in adherence to taking medication and medical follow-ups in children who received liver transplants, because there is no transition strategy for those children and parents or guardians. The objective of this study is to measure the effect of nature and outdoor activity to improve children's medical adherence. METHODS We recruited participants from 9-year-old children who are attending the outpatient liver transplant clinic in a stable condition (no event such as rejection or surgical procedure within 6 months). We took participants to a snow camp and measured its effect by using the IKIRU CHIKARA (IKR) tool, which contain 28 items divided into 3 categories: psychosocial ability, moral fitness, and physical ability. Children were tested on three occasions, before, just after, and 1 month after the camp. RESULTS Eight patients participated in the snow camp and 7 patients were eligible for the study. The average age was 12.6 with a range 10 to 17 years. There were 3 girls and 4 boys. The average IKR scores before, just after, and 1 month after the camp were 127.9, 131.5, and 126.6, respectively. CONCLUSION An outdoor activity such as a snow camp can be safely conducted, and it is an acceptable option to incorporate within a pediatric liver transplant program. There were no significant changes in IKR scores during this short observation. Longer observation is needed to measure the effect of nature and outdoor activities.
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Affiliation(s)
- E Soeda
- Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan.
| | - K Hoshino
- School of Medicine, Keio University, Tokyo, Japan
| | - Y Izawa
- Department of Nursing, Keio University Hospital, Tokyo, Japan
| | - C Takaoka
- Department of Nursing, Keio University Hospital, Tokyo, Japan
| | - C Isobe
- School of Nursing, Shibuya Medical Association, Tokyo, Japan
| | | | - N Takahashi
- School of Medicine, Keio University, Tokyo, Japan
| | - Y Yamada
- School of Medicine, Keio University, Tokyo, Japan
| | - N Shimojima
- School of Medicine, Keio University, Tokyo, Japan
| | - A Fujino
- School of Medicine, Keio University, Tokyo, Japan
| | - M Shinoda
- School of Medicine, Keio University, Tokyo, Japan
| | - Y Kitagawa
- School of Medicine, Keio University, Tokyo, Japan
| | - M Tanabe
- Faculty of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - S Nakamaru
- Faculty of Health and Sports Science, Juntendo University, Chiba, Japan
| | - N Taki
- Faculty of Educatoin, Shinshu University, Nagano, Japan
| | - A Sekiguchi
- Japanese Center for Research on Women in Sports, Juntendo University, Tokyo, Japan
| | | | | | - T Kuroda
- School of Medicine, Keio University, Tokyo, Japan
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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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