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Düken ME, Yayan EH. Psychosocial conditions of children after liver transplant: Post-traumatic stress, depression, and anxiety. J Pediatr Nurs 2024; 75:e75-e80. [PMID: 38216348 DOI: 10.1016/j.pedn.2023.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 12/29/2023] [Accepted: 12/29/2023] [Indexed: 01/14/2024]
Abstract
AIM This study aimed to determine psychosocial conditions, post-traumatic stress, depression, and anxiety of children who underwent a liver transplant. METHOD This is a relational descriptive study, which was conducted between March 2019 and December 2020 in the Inonu University Liver Transplantation Institute Pediatric Liver Transplant Clinic. The "Child Information Form," "Child Post-Traumatic Stress Reaction Index," "State-Trait Anxiety Inventory for Children-Trait Form," and "Children's Depression Inventory" were used to collect data. The study was conducted with 71 children who had a previous liver transplant. RESULTS Of the participating children, 56.3% were girls, 63.4% continued their primary school education after the transplant, 32.5% were diagnosed with cirrhosis, 39.4% received the transplant in 2017, 32.4% received it from the mother, and 25.4% received it from a cadaveric donor. Although it had been at least 3 years since the transplant, 47.9% exhibited moderate and 43.7% severe post-traumatic stress responses. There was a significant negative relationship between the age of children with a liver transplant and trait anxiety and post-traumatic stress responses (path coefficients β = -0.268, p = 0.002; β = -0.166, p = 0.023, respectively). There was a significant positive relationship between anxiety and post-traumatic stress responses of the children after the transplant and there was a statistically significant relationship between the path coefficients (β = 0.750; p < 0.001). CONCLUSION Children who underwent a liver transplant had post-traumatic stress disorder, depression, and trait anxiety.
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Affiliation(s)
- Mehmet Emin Düken
- Harran University, Health Sciences of Faculty -Department of Child Health and Diseases Nursing, Şanlıurfa 63000, Turkey; Inönü University, Faculty of Nursing- Department of Child Health and Diseases Nursing, Malatya 44280, Turkey.
| | - Emriye Hilal Yayan
- Inönü University, Faculty of Nursing- Department of Child Health and Diseases Nursing, Malatya 44280, Turkey.
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Garrido-Bolton J, Alcamí-Pertejo M, de la Vega R, Hernández-Oliveros F, Pérez-Martínez A, Bravo-Ortiz MF, Fernández-Jiménez E. Neuropsychological and biopsychosocial evolution, therapeutic adherence and unmet care needs during paediatric transplantation: study protocol of a mixed-methods design (observational cohort study and focus groups) - the TransplantKIDS mental health project. Front Psychol 2024; 15:1308418. [PMID: 38449767 PMCID: PMC10915199 DOI: 10.3389/fpsyg.2024.1308418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/11/2024] [Indexed: 03/08/2024] Open
Abstract
The present article describes the protocol of a mixed-methods study (an observational cohort design and focus groups), aimed to examine neuropsychological functioning and other biopsychosocial outcomes, therapeutic adherence and unmet care needs in paediatric population undergoing solid organ or allogeneic hematopoietic transplant during the pre- and post-transplant phases. Following a multi-method/multi-source approach, neuropsychological domains will be comprehensively measured with objective tests (SDMT, K-CPT 2/CPT 3, TAVECI/TAVEC, WISC-V/WAIS-IV Vocabulary and Digit Span subtests, Verbal Fluency tests, Stroop, ROCF, and TONI-4); ecological executive functioning, affective and behavioral domains, pain intensity/interference, sleep quality and therapeutic adherence will be assessed through questionnaires (parent/legal guardians-reported: BRIEF-2 and BASC-3; and self-reported: BASC-3, BPI, PROMIS, AIQ and SMAQ); and blood levels of prescribed drugs will be taken from each patient's medical history. These outcomes will be measured at pre-transplant and at 4-weeks and 6-months post-transplant phases. The estimated sample size was 60 patients (any type of transplant, solid organ, or hematopoietic) from La Paz University Hospital (Madrid, Spain). Finally, three focus group sessions will be organized with patients, parents/guardians, and transplant clinicians (n = 15, with 5 participants per group), in order to qualitatively identify unmet care needs during the pre-, and post-transplant stages of the process. The study protocol was registered at ClinicalTrials.gov (NCT05441436).
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Affiliation(s)
- Jessica Garrido-Bolton
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
| | - Margarita Alcamí-Pertejo
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
| | - Rocío de la Vega
- Department of Personality, Evaluation and Psychological Treatment, University of Málaga, Málaga, Spain
- Instituto Biomédico de Málaga – IBIMA Plataforma Bionand, Málaga, Spain
| | | | - Antonio Pérez-Martínez
- Department of Pediatric Hemato-Oncology, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
- Department of Pediatrics, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - María Fe Bravo-Ortiz
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Eduardo Fernández-Jiménez
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
- Faculty of Social Sciences and Communication, Universidad Europea de Madrid, Madrid, Spain
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Holmen H, Winger A, Steindal SA, Riiser K, Castor C, Kvarme LG, Mariussen KL, Lee A. Patient-reported outcome measures in children, adolescents, and young adults with palliative care needs-a scoping review. BMC Palliat Care 2023; 22:148. [PMID: 37798706 PMCID: PMC10557323 DOI: 10.1186/s12904-023-01271-9] [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: 06/08/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Measuring outcomes facilitates evaluation of palliative services for children, adolescents, and young adults (CAYAs) with life-limiting and/or life-threatening (LL/LT) conditions. Implementation of patient-reported, proxy-reported, or patient-centered outcome measures (hereafter PROMs) is recommended to ensure palliative services. The purpose of this scoping review was to provide an overview of PROMs relevant for CAYAs living with LL/LT conditions eligible for pediatric palliative care (PPC). METHODS Arksey and O'Malley's 6-stage scoping review framework was used to guide the review. The identified citations had to report on PROMs in any context including CAYAs with LL/LT conditions up to 25 years of age. A systematic search of Medline, EMBASE, CINAHL, APA PsycInfo, Health and Psychosocial Instruments, and AMED took place in January 2021 and was updated in June 2022. Citations were screened independently by pairs of researchers. The scoping review protocol was registered, and peer-review published. RESULTS Of 3690 identified citations, 98 reports were included, of which the majority were from Western countries and about PROMs in CAYAs living with cancer or organ failure. A total of 80 PROMs were identified, assessing a range of phenomena, where quality of life and symptoms (especially pain) during the stage of ongoing care were the most frequent. There were only a few reports about outcome measures at time of diagnosis or in end-of-life care. CAYAs self-reported on the PROMs or collaborated with their parents in about half of the reports, while the remaining had proxies answering on behalf of the CAYAs. In the identified reports, PROMs were used to characterize a sample through cross-sectional or longitudinal research, and less often to assess effects of interventions. CONCLUSION The identified PROMs in the CAYA population eligible for PPC is characterized by studies in high-income countries during ongoing care, primarily in patients with cancer or organ failure. More research is needed in patients living with other LL/LT conditions, and during different stages of the disease course, especially at time of diagnosis, during transition to adulthood, and in end-of-life care. This scoping review of PROMs relevant for young patients eligible for PPC may inform future research about patient-/proxy-reported or patient-centered outcome measures in PPC. TRIAL REGISTRATION Review registration: ( https://osf.io/yfch2/ ) and published protocol (Holmen et al. Syst Rev. 10:237, 2021).
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Affiliation(s)
- Heidi Holmen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Place, Post Box 4, 0130, Oslo, Norway.
| | - Anette Winger
- Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Place, Post Box 4, 0130, Oslo, Norway
| | - Simen A Steindal
- Lovisenberg Diaconal University College, Lovisenberggt, 15B, 0456, Oslo, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | - Kirsti Riiser
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, St. Olavs Place, Post Box 4, 0130, Oslo, Norway
| | - Charlotte Castor
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden
| | - Lisbeth Gravdal Kvarme
- Department of Nursing and Health Promotion, Oslo Metropolitan University, St. Olavs Place, Post Box 4, 0130, Oslo, Norway
| | - Kari L Mariussen
- Lovisenberg Diaconal University College, Lovisenberggt, 15B, 0456, Oslo, Norway
| | - Anja Lee
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital HF, Nydalen, Box 4950, 0424, Oslo, Norway
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Zimbrean PC. Depression in transplantation. Curr Opin Organ Transplant 2022; 27:535-545. [PMID: 36227755 DOI: 10.1097/mot.0000000000001024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW To review and summarize the literature published between 1 January 2020 and 30 June 2022, on the prevalence, risk factors and impact of depression in transplant population. RECENT FINDINGS Depression is common in transplantation candidates and recipients, with a prevalence up to 85.8% in kidney recipients. Multiple studies have indicated after transplantation depression correlates with increased mortality and with higher healthcare utilization. Social risk factors for posttransplant depression include financial difficulties and unemployment, while less is understood about the biological substrate of depression in this population. There is evidence that dynamic psychotherapy is effective for depression in organ transplant recipients, while cognitive behavioral therapy or supportive therapy did not lead to improvement of depression in transplant recipients. For living organ donors, the rates of depression are similar to the general population, with financial factors and the clinical status of the recipient playing a significant role. SUMMARY Depression is a common finding in transplant population. More research is needed to understand the biological substrate and risk factors and to develop effective treatment interventions.
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Affiliation(s)
- Paula C Zimbrean
- Departments of Psychiatry and Surgery (Transplantation), Yale University School of Medicine, New Haven, Connecticut, USA
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Düken ME, Zengin M, Yayan EH. The effect of perceived social support on the psychosocial status of parents whose child had liver transplantation. J Pediatr Nurs 2022; 66:e130-e136. [PMID: 35527086 DOI: 10.1016/j.pedn.2022.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of this study was to describe parental psychosocial outcomes following paediatric liver transplantation and the relationship between parental psychosocial outcomes and social support. METHOD This is a correlational, descriptive study conducted between April 2021 and October 2021 in the paediatric hepatology polyclinics of the liver transplantation institute of a university hospital. The SPSS 25 and AMOS 23 package programmes were used to perform data analyses. RESULTS Data analysis revealed that the parents' social support level was low (44.6 ± 14.8), while their levels of trait anxiety (51.5 ± 4.8) and loneliness (48.5 ± 5.4) were high, and their depression level was moderate (26.4 ± 5.8). Established structural equation modelling demonstrated that the social support parents received had a significant effect on their levels of loneliness (β = -0.88; p < 0.001), trait anxiety (β = -0.37; p < 0.001), and depression (β = -0.44; p < 0.001). CONCLUSION The authors conclude that in parents of children who have had a liver transplant, increased levels of perceived social support result in decreased levels of anxiety, loneliness, and depression. PRACTICE IMPLICATIONS The authors recommend that healthcare professionals can contribute to reducing the anxiety, loneliness and depression in parents of paediatric liver transplant recipients by strengthening their social support systems.
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Affiliation(s)
- Mehmet Emin Düken
- Department of Child Health and Diseases Nursing, Faculty of Health Sciences, Harran University, Şanlıurfa, Turkey
| | - Mürşide Zengin
- Department of Child Health and Diseases Nursing, Faculty of Health Sciences, Adıyaman University, Adıyaman, Turkey.
| | - Emriye Hilal Yayan
- Department of Child Health and Diseases Nursing, Faculty of Nursing, İnönü University, Malatya, Turkey
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Triplett KN, Mayersohn GS, Masood SS, Pickwith K, Mbroh H, Killian M. Posttraumatic Growth in Youth, Young Adults, and Caregivers Who Experienced Solid Organ Transplant. J Pediatr Psychol 2021; 47:965-977. [PMID: 34957509 DOI: 10.1093/jpepsy/jsab134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/01/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To explore posttraumatic growth (PTG) in pediatric patients who have undergone solid organ transplant (SOT) and their caregivers, and to examine potential correlates of PTG. METHOD Youth and young adults with a history of SOT (heart, kidney, liver) at least 1 month prior to participation and caregivers completed measures of PTG, demographic, and medical factors. In total, 59 youth (M = 12.68 years, SD = 1.91), 21 young adults (M = 19.37, SD = 0.82), and 95 caregivers (M = 37.95 years, SD = 9.37) participated. RESULTS Overall, 67% of youth, 76% of young adults, and 89% of caregivers reported PTG within the medium to very high range. Appreciation of Life was the highest PTG subscale across all groups. Youth and caregiver PTG scores were significantly positively correlated. Religious affiliation and religious coping were positively associated with PTG for caregivers, and the relationship yielded large effect sizes for young adults. Caregivers of children with kidney transplants endorsed lower PTG than other organ types and caregivers of children who had an acute medical condition endorsed greater PTG than caregivers of children who had chronic illness. CONCLUSION Findings suggest the pediatric SOT experience can yield positive changes such as a greater appreciation of life. Although small sample sizes may have led to reduced power for detecting significant findings for some analyses, results suggest religious, medical, and parent-child relationship factors are likely related to PTG in pediatric SOT and warrant future investigation.
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Affiliation(s)
- Kelli N Triplett
- Department of Solid Organ Transplant, Children's Medical Center Dallas, Dallas, TX, USA.,Department of Psychiatry, University of Texas Southwestern, Dallas, TX, USA
| | - Gillian S Mayersohn
- Department of Psychology, St. Louis Children's Hospital, St. Louis, MO, USA.,Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Saba S Masood
- Department of Solid Organ Transplant, Children's Medical Center Dallas, Dallas, TX, USA.,Department of Psychiatry, University of Texas Southwestern, Dallas, TX, USA
| | - Kristine Pickwith
- Department of Solid Organ Transplant, Children's Medical Center Dallas, Dallas, TX, USA
| | - Hayden Mbroh
- Department of Psychiatry, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Psychiatry, University of Southern California, Los Angeles, CA, USA
| | - Michael Killian
- College of Social Work, Florida State University, Tallahassee, FL, USA
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Demir B, Demir İ. Effects of Illness Perception on Self-Care Agency and Hopelessness Levels in Liver Transplant Patients: A Descriptive Cross-Sectional Study. Clin Nurs Res 2021; 31:473-480. [PMID: 34362267 DOI: 10.1177/10547738211036983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Individuals with liver transplantation (LT), hopelessness, and lack of self-care may occur and change in the illness perceptions; however, no study has examined the effects of the illness perceptions on self-care agency and hopelessness levels in individuals with LT. This study was conducted to examine the effects of the illness perceptions of patients who had received LT surgery on their self-care agency and hopelessness levels. A descriptive cross-sectional study with a convenience sample (N = 120) was conducted at a center in eastern Turkey. The data were collected by using the "Brief Illness Perception Questionnaire" (B-IPQ), "Self-Care Agency Scale" (SCAS), "Beck Hopelessness Scale" (BHS). In the study, the mean total B-IPQ, SCAS, BHS scores was found as 57.50 ± 3.61, 83.83 ± 9.43, 10.19 ± 3.81, respectively. There was a positive and significant relationship between the B-IPQ and BHS total scores.
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Hind T, Lui S, Moon E, Broad K, Lang S, Schreiber RA, Armstrong K, Blydt-Hansen TD. Post-traumatic stress as a determinant of quality of life in pediatric solid-organ transplant recipients. Pediatr Transplant 2021; 25:e14005. [PMID: 33769652 DOI: 10.1111/petr.14005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 02/08/2021] [Accepted: 02/16/2021] [Indexed: 01/15/2023]
Abstract
Living with end-stage organ failure is associated with an accumulation of traumatic medical events, and despite recovery after solid-organ transplantation (SOT), many children continue to exhibit lower quality of life (QOL). Few studies have examined the relationship between post-traumatic stress disorder (PTSD) and QOL among pediatric SOT recipients. We conducted a retrospective, cross-sectional review of 61 pediatric SOT recipients (12 heart, 30 kidney, and 19 liver) to evaluate the association of PTSD with self-reported QOL. PTSD was measured by the Child Trauma Screening Questionnaire (CTSQ), and QOL was measured using the PedsQL and PedsQL Transplant Module (PedsQL-TM) surveys. Demographics, baseline, and contemporaneous factors were tested for independent association. SOT recipients were 15.2 (12.1-17.6) years old at survey completion. Median CTSQ score was 2 (1-3), highest in kidney recipients, and 13% were identified as high risk for PTSD. Median PedsQL score was 83 (70-91) and significantly associated with the CTSQ score (r = -.68, p < .001). Median PedsQL Transplant Module score was 89 (83-95) and similarly associated with the CTSQ score (r = -.64, p < .001). Age at time of surveys and presence of any disability were also independently associated with PedsQL and PedsQL-TM, respectively. When adjusted for Emotional Functioning, CTSQ remained associated with PedsQL subscores (r = -.65, p < .001). Trauma symptoms are a major modifiable risk factor for lower self-perceived QOL and represent a potentially important target for post-transplant rehabilitation. Additional research is needed to understand the root contributors to PTSD and potential treatments in this population.
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Affiliation(s)
- Tatsuma Hind
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Samantha Lui
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Erin Moon
- Department of Psychology, BC Children's Hospital, Vancouver, BC, Canada
| | - Katherine Broad
- Social Work, Pediatric Multi-Organ Transplant Program, BC Children's Hospital, Vancouver, BC, Canada
| | - Samantha Lang
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Richard A Schreiber
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, BC Children's Hospital, Vancouver, BC, Canada
| | - Kathryn Armstrong
- Department of Pediatrics, Division of Cardiology, BC Children's Hospital, Vancouver, BC, Canada
| | - Tom D Blydt-Hansen
- Pediatric Multi-Organ Transplant Program, BC Children's Hospital, Vancouver, BC, Canada
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Courbage S, Canioni D, Talbotec C, Lambe C, Chardot C, Rabant M, Galmiche L, Corcos O, Goulet O, Joly F, Lacaille F. Beyond 10 years, with or without an intestinal graft: Present and future? Am J Transplant 2020; 20:2802-2812. [PMID: 32277553 DOI: 10.1111/ajt.15899] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 03/12/2020] [Accepted: 03/18/2020] [Indexed: 01/25/2023]
Abstract
Long-term outcomes in children undergoing intestinal transplantation remain unclear. Seventy-one children underwent intestinal transplantation in our center from 1989 to 2007. We report on 10-year posttransplant outcomes with (group 1, n = 26) and without (group 2, n = 9) a functional graft. Ten-year patient and graft survival rates were 53% and 36%, respectively. Most patients were studying or working, one third having psychiatric disorders. All patients in group 1 were weaned off parenteral nutrition with mostly normal physical growth and subnormal energy absorption. Graft histology from 15 late biopsies showed minimal abnormality. However, micronutrient deficiencies and fat malabsorption were frequent; biliary complications occurred in 4 patients among the 17 who underwent liver transplantation; median renal clearance was 87 mL/min/1.73 m2 . Four patients in group 1 experienced late acute rejection. Among the 9 patients in group 2, 4 died after 10 years and 2 developed significant liver fibrosis. Liver transplantation and the use of a 3-drug regimen including sirolimus or mycophenolate mofetil were associated with improved graft survival. Therefore, intestinal transplantation may enable a satisfactory digestive function in the long term. The prognosis of graft removal without retransplantation is better than expected. Regular monitoring of micronutrients, early psychological assessment, and use of sirolimus are recommended.
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Affiliation(s)
- Sophie Courbage
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Danielle Canioni
- Department of Pathology, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Cécile Talbotec
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Cécile Lambe
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Christophe Chardot
- Department of Pediatric Surgery, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Marion Rabant
- Department of Pathology, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Louise Galmiche
- Department of Pathology, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Olivier Corcos
- Department of Gastroenterology, Nutrition Support and Intestinal Transplantation, Beaujon Hospital, University of Paris, Clichy, France
| | - Olivier Goulet
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Francisca Joly
- Department of Gastroenterology, Nutrition Support and Intestinal Transplantation, Beaujon Hospital, University of Paris, Clichy, France
| | - Florence Lacaille
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Necker-Enfants Malades Hospital, University of Paris, Paris, France
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