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Vittorio J, Kosmach-Park B, Wadhwani S, Jackson W, Kerkar N, Corbo H, Vekaria P, Gupta N, Yeh H, King LY. Adult provider role in transition of care for young adult pediatric recipients of liver transplant: An expert position statement. Hepatol Commun 2024; 8:e0486. [PMID: 39023314 PMCID: PMC11262821 DOI: 10.1097/hc9.0000000000000486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 07/20/2024] Open
Abstract
Health care transition (HCT) is the process of changing from a pediatric to an adult model of care. Young adult pediatric recipients of liver transplant transferring from pediatric to adult health care services are highly vulnerable and subject to poor long-term outcomes. Barriers to successful transition are multifaceted. A comprehensive HCT program should be initiated early in pediatrics and continued throughout young adulthood, even after transfer of care has been completed. It is critical that pediatric and adult liver transplant providers establish a partnership to optimize care for these patients. Adult providers must recognize the importance of HCT and the need to continue the transition process following transfer. While this continued focus on HCT is essential, current literature has primarily offered guidance for pediatric providers. This position paper outlines a framework with a sample set of tools for the implementation of a standardized, multidisciplinary approach to HCT for adult transplant providers utilizing "The Six Core Elements of HCT." To implement more effective strategies and work to improve long-term outcomes for young adult patients undergoing liver transplant, HCT must be mandated as a routine part of posttransplant care. Increased advocacy efforts with the additional backing and support of governing organizations are required to help facilitate these practices.
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Affiliation(s)
- Jennifer Vittorio
- Department of Pediatrics, New York University (NYU) Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Beverly Kosmach-Park
- Department of Transplant Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sharad Wadhwani
- Department of Pediatrics, University of California-San Francisco, San Francisco, California, USA
| | - Whitney Jackson
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nanda Kerkar
- Department of Pediatrics, University of Rochester Medical Center, New York, New York, USA
| | - Heather Corbo
- Department of Pharmacy, New York-Presbyterian Hospital, New York, New York, USA
| | - Pooja Vekaria
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Nitika Gupta
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Heidi Yeh
- Division of Transplant Surgery, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lindsay Y King
- Division of Gastroenterology, Department of Medicine, Duke University Health System, Durham, North Carolina, USA
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2
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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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Kortbeek S, Anderson SG, Alonso EM, Rand EB, Bucuvalas J, Mazariegos GV, Campbell KM, Lobritto SJ, Feldman AG, Mysore KR, Anand R, Selzner N, Ng VL. Immunosuppression-Free Life after Pediatric Liver Transplant: A Case-Control Study from the Society of Pediatric Liver Transplant (SPLIT) Registry. J Pediatr 2024; 264:113744. [PMID: 37726087 DOI: 10.1016/j.jpeds.2023.113744] [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: 05/12/2023] [Revised: 08/29/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE To compare long-term outcomes of pediatric liver transplant (LT) recipients off immunosuppression (IS) with matched controls on IS using data from the Society of Pediatric Liver Transplant (SPLIT) registry. STUDY DESIGN This was a retrospective case-control study. SPLIT participants <18 years of age, ≥4 years after isolated LT, and off IS for ≥1 year (cases) were age- and sex-matched 1:2 to patients with the same primary diagnosis and post-LT follow-up duration (controls). Primary outcomes included retransplantation, allograft rejection, IS comorbidities, and prevalence of SPLIT-derived composite ideal outcome (c-IO) achieved at the end of the follow-up period. Differences were compared using multiple linear regression for continuous outcomes and logistic regression for dichotomous data. RESULTS The study cohort was composed of 33 cases (42.4% male, 60.6% biliary atresia, median age at LT of 0.7 [P25, P75, 0.5, 1.6] years, median IS withdrawal time of 9 [P25, P75, 6, 12] years after LT) and 66 age- and sex-matched controls. No cases required retransplantation. Cases and controls had similar growth parameters, laboratory values, calculated glomerular filtration rates, rates of post-transplant lymphoproliferative disease, graft rejection, and attainment of c-IO. CONCLUSIONS No differences in allograft rejection rates, IS complications, or c-IO prevalence were seen between SPLIT patients off IS and age- and sex-matched controls remaining on IS. Discontinuation of IS most commonly occurred in the context of rigorously designed IS withdrawal trials. The available sample size was small, affecting generalizability to the broader pediatric LT population.
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Affiliation(s)
- Simone Kortbeek
- Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Estella M Alonso
- Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elizabeth B Rand
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA
| | - John Bucuvalas
- Division of Pediatric Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - George V Mazariegos
- Division of Transplantation Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kathleen M Campbell
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Steven J Lobritto
- Division of Gastroenterology, Hepatology, and Nutrition, Columbia University Irving Medical Center, New York, NY
| | - Amy G Feldman
- Division of Pediatrics, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Digestive Health Institute, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Krupa R Mysore
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | | | - Nazia Selzner
- Ajmera Transplant Center, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vicky L Ng
- Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Batsis I, Bucuvalas J, Eisenberg E, Lau J, Squires JE, Feng S, Perito ER. Immunosuppression after pediatric liver transplant: The parents' perspective. Clin Transplant 2023; 37:e14931. [PMID: 36774540 DOI: 10.1111/ctr.14931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/12/2023] [Accepted: 02/03/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND For children with liver transplants (LT), achieving an "ideal outcome" is a balancing act: too little immunosuppression begets graft injury; too much begets systemic complications. We aimed to delineate the parental perspective on this tightrope. METHODS Parents of children with LT completed an internet-based survey about their child's immunosuppression. RESULTS Children of respondents (n = 82) were a median 4 years from primary LT (range 0-22); 73% were on immunosuppression monotherapy. Parents' top concerns were related to immunosuppression complications; 46% were more concerned about immunosuppression complications than rejection; only 17% were more concerned about rejection than immunosuppression complications. Among parents of children on immunosuppression monotherapy, 29% still worried more about immunosuppression complications than rejection, 48% expressed equal concern for both. Time since LT (0-4 vs. >4 years) was not associated with concern level for rejection or immunosuppression complications. Caregivers were significantly more certain that their child's immunosuppression regimen was correct to prevent rejection than to mitigate complications (p < .005). CONCLUSION Caregivers of children with LTs reported higher levels of concern and uncertainty about immunosuppression complications than rejection risk. Understanding parent and patient perspectives on IS, and incorporating them into immunosuppression counseling and decision-making, is critical to achieving truly "ideal" long-term outcomes.
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Affiliation(s)
- Irini Batsis
- Department of Pediatrics, Icahn School of Medicine, Kravis Children's Hospital at Mount Sinai, New York, New York, USA
| | - John Bucuvalas
- Department of Pediatrics, Icahn School of Medicine, Kravis Children's Hospital at Mount Sinai, New York, New York, USA
| | | | - Jennifer Lau
- Patient and Family Engaged Partners, Society for Pediatric Liver Transplantation, Palo Alto, California, USA
| | - James E Squires
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sandy Feng
- Department of Pediatrics, San Francisco School of Medicine, University of California, San Francisco, California, USA
| | - Emily R Perito
- Department of Pediatrics, San Francisco School of Medicine, University of California, San Francisco, California, USA
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Perez A, Ovchinsky N. Caring for a child after a liver transplant: Challenges beyond medical complexity. Liver Transpl 2022; 28:1707-1708. [PMID: 35779249 DOI: 10.1002/lt.26540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Adriana Perez
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital at Montefiore-Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nadia Ovchinsky
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital at Montefiore-Albert Einstein College of Medicine, Bronx, New York, 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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Stasch L, Ohlendorf J, Baumann U, Ernst G, Lange K, Konietzny C, Pfister ED, Sautmann K, Goldschmidt I. Parental Disease Specific Knowledge and Its Impact on Health-Related Quality of Life. CHILDREN (BASEL, SWITZERLAND) 2022; 9:98. [PMID: 35053722 PMCID: PMC8774947 DOI: 10.3390/children9010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/08/2021] [Accepted: 12/28/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Structured education programs have been shown to improve somatic outcome and health-related quality of life (HRQOL) in a variety of chronic childhood diseases. Similar data are scarce in paediatric liver transplantation (pLTx). The purpose of this study was to examine the relationship of parental disease-specific knowledge and psychosocial disease outcome in patients after pLTx. METHODS Parents of 113 children (chronic liver disease n = 25, after pLTx n = 88) completed the transplant module of the HRQOL questionnaire PedsQL, the "Ulm quality of life inventory for parents of children with chronic diseases" ULQUI, and a tailor-made questionnaire to test disease-specific knowledge. RESULTS Parental knowledge was highest on the topic of "liver transplantation" and lowest in "basic background knowledge" (76% and 56% correct answers respectively). Knowledge performance was only marginally associated with HRQOL scores, with better knowledge being related to worse HRQOL outcomes. In contrast, self-estimation of knowledge performance showed significant positive correlations with both PedsQL and ULQUI results. CONCLUSION Patient HRQOL and parental emotional wellbeing after pLTx are associated with positive self-estimation of parental disease-specific knowledge. Objective disease-specific knowledge has little impact on HRQOL. Parental education programs need to overcome language barriers and address self-efficacy in order to improve HRQOL after pLTx.
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Affiliation(s)
- Luisa Stasch
- Division of Paediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany; (L.S.); (U.B.); (C.K.); (E.-D.P.); (I.G.)
| | - Johanna Ohlendorf
- Division of Paediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany; (L.S.); (U.B.); (C.K.); (E.-D.P.); (I.G.)
| | - Ulrich Baumann
- Division of Paediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany; (L.S.); (U.B.); (C.K.); (E.-D.P.); (I.G.)
| | - Gundula Ernst
- Medical Psychology, Hannover Medical School, 30625 Hannover, Germany; (G.E.); (K.L.); (K.S.)
| | - Karin Lange
- Medical Psychology, Hannover Medical School, 30625 Hannover, Germany; (G.E.); (K.L.); (K.S.)
| | - Christiane Konietzny
- Division of Paediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany; (L.S.); (U.B.); (C.K.); (E.-D.P.); (I.G.)
| | - Eva-Doreen Pfister
- Division of Paediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany; (L.S.); (U.B.); (C.K.); (E.-D.P.); (I.G.)
| | - Kirsten Sautmann
- Medical Psychology, Hannover Medical School, 30625 Hannover, Germany; (G.E.); (K.L.); (K.S.)
| | - Imeke Goldschmidt
- Division of Paediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany; (L.S.); (U.B.); (C.K.); (E.-D.P.); (I.G.)
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McLoughlin A, Wilson C, Swords L. Parents' Experiences of Their Child's Solid-Organ Transplant: A Meta-Ethnography of Qualitative Studies. J Pediatr Psychol 2021; 47:279-291. [PMID: 34664643 DOI: 10.1093/jpepsy/jsab108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/25/2021] [Accepted: 09/25/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The aim of this paper was to conduct a systematic review and meta-ethnography of qualitative studies examining the experiences of parents adjusting to life after the solid organ transplant (SOT) of their child. METHODS A systematic review of the literature was conducted to identify qualitative studies that examined this topic. The search retrieved 4,964 studies to review against inclusion criteria. A total of 21 studies were included in the meta-ethnography. A reciprocal translation was conducted to compare themes identified in each study. A line of argument synthesis was then conducted in order to integrate the similarities and differences between all of the studies into a new interpretative context. RESULTS The synthesis identified four themes: (a) adjusting to life after transplant, (b) factors that facilitate adjustment, (c) factors that disrupt adjustment, and (d) changes caused by transplant. As a result of the synthesis, a new interpretation of parents' experiences of adjusting to life after the SOT of their child was constructed. A summary figure is presented. CONCLUSION This review found that while parents may struggle to adapt to life post-transplant and the demands of caring for their child, the experience can also result in the development of new skills, a new appreciation for life, and viewing the self in a more positive manner. A better understanding of parental experiences will promote the development of more effective interventions for the adjustment of parents and families to post-transplant life.
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Two Sides of a Coin: Parental Disease-Specific Training as Seen by Health Care Practitioners and Parents in Pediatric Liver Transplantation. CHILDREN 2021; 8:children8090827. [PMID: 34572259 PMCID: PMC8469562 DOI: 10.3390/children8090827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/03/2021] [Accepted: 09/15/2021] [Indexed: 12/04/2022]
Abstract
In the absence of widely accepted education standards for parents of children after liver transplantation (LTx), the content and structure of parental training are influenced by health care practitioners’ (HCP) individual knowledge and assessment of the relevance of its contents. This study examines the hypothesis that expectations towards training differ between HCPs and parents, and that the quality of parental training affects the job-satisfaction of HCPs. Attitudes towards disease-specific education were assessed by tailor-made questionnaires in HCPs (n = 20) and parents of children with chronic liver disease or after LTx (n = 113). These were supplemented by focused interviews in n = 7 HCPs and n = 16 parents. Parents were more satisfied with current counseling than HCP. Language barriers and low parental educational background were perceived as obstacles by 43% of HCPs. The quality of parental knowledge was felt to have a strong influence on HCPs job satisfaction. The expectations towards the content of disease-specific education largely overlap but are not synonymous. HCP and parents agreed with regards to the importance of medication knowledge. Parents rated the importance about the meaning of laboratory values and diagnostic procedures significantly higher (3.50 vs. 2.85, p < 0.001 and 3.42 vs. 2.80, p < 0.001) than HCPs. Parents and HCPs would prefer a structured framework with sufficient staff resources for disease-specific counseling.
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Wang Y, Hua L, Zou S, Deng T, Chen Y, Cao W, Wu C, Zhou Y, Zou H. The Homeless People in China During the COVID-19 Pandemic: Victims of the Strict Pandemic Control Measures of the Government. Front Public Health 2021; 9:679429. [PMID: 34458220 PMCID: PMC8387877 DOI: 10.3389/fpubh.2021.679429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/16/2021] [Indexed: 12/16/2022] Open
Abstract
Background: By implementing aggressive control measures, China has rapidly and effectively controlled the Coronavirus disease 2019 (COVID-19) pandemic. However, the neglected homeless population may become victims of that perceived success. Due to political sensitivity, we know little about them. Aims: This study aimed to investigate how the pandemic and the pandemic control strategies of the government affected the lives of the homeless people in mainland China. Methods: A total of 103 eligible participants experiencing absolute homelessness were recruited from Guangzhou City during July and August 2020. Surveys measured demographic characteristics including health status, changes in daily living, and actions of the government toward the homeless during the pandemic. Sankey diagrams and ordered logit regression models were used to examine the impact on the homeless of inhumane government efforts to drive the homeless away. Qualitative materials were analyzed by using an inductive approach to provide more details. Results: First, the homeless people in Guangzhou tended to be male, aged 40 to 64 years, less well-educated, and they originated from outside Guangdong although they were living in the city center. Most had little connection with their families. After a long period of homelessness, almost half of the participants were in poor health with various conditions, which made them extremely vulnerable to COVID-19. Second, the pandemic caused a substantial decline in incomes of homeless people, had less of a negative impact on their food intake, and affected sleep time in different ways. Third, during the COVID-19 pandemic, humanitarian aid from local governments of China decreased, whereas inhumane efforts to drive the homeless away intensified. Fourth, quantitative models and qualitative materials demonstrate the devastating effect of the strict pandemic control strategy of the government on the lives of homeless people, which may further cause their health problems. Conclusion: This study for the first time illustrated the characteristic features of the street homeless population in mainland China and their living situation during the COVID-19 pandemic, and most importantly demonstrated the devastating effect of the strict pandemic control of the government, which has been considered a great success in previous studies, on lives of homeless people. Urgent measures should be taken to ensure the protection of the homeless population and prevent an impending humanitarian crisis.
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Affiliation(s)
- Ying Wang
- School of Public Policy and Administration, Chongqing University, Chongqing, China
| | - Lei Hua
- School of Public Administration, Nanfang College of Sun Yat-sen University, Guangzhou, China
- College of Attainment, Nanfang College of Sun Yat-sen University, Guangzhou, China
- School of Government, Sun Yat-sen University, Guangzhou, China
| | - Shuyun Zou
- School of Public Administration, Nanfang College of Sun Yat-sen University, Guangzhou, China
- College of Attainment, Nanfang College of Sun Yat-sen University, Guangzhou, China
| | - Taofeng Deng
- School of Public Administration, Nanfang College of Sun Yat-sen University, Guangzhou, China
- College of Attainment, Nanfang College of Sun Yat-sen University, Guangzhou, China
| | - Yongqi Chen
- School of Public Administration, Nanfang College of Sun Yat-sen University, Guangzhou, China
- College of Attainment, Nanfang College of Sun Yat-sen University, Guangzhou, China
| | - Wanying Cao
- School of Public Administration, Nanfang College of Sun Yat-sen University, Guangzhou, China
- College of Attainment, Nanfang College of Sun Yat-sen University, Guangzhou, China
| | - Chuhan Wu
- School of Public Administration, Nanfang College of Sun Yat-sen University, Guangzhou, China
| | - Yujie Zhou
- School of Public Administration, Nanfang College of Sun Yat-sen University, Guangzhou, China
| | - Hua Zou
- School of Public Administration, Nanfang College of Sun Yat-sen University, Guangzhou, China
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Hager A, Mager D, Robert C, Nicholas D, Gilmour S. Health-Related Quality of Life 10 Years after Liver Transplantation: A Longitudinal Retrospective Review. Diagnostics (Basel) 2021; 11:diagnostics11010111. [PMID: 33445652 PMCID: PMC7827867 DOI: 10.3390/diagnostics11010111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 02/07/2023] Open
Abstract
As survival post-liver transplantation (LTx) improves, it becomes increasingly important to understand how long-term health-related quality of life (HRQOL) is impacted. This was a longitudinal review examining HRQOL measured by Pediatric Liver Transplant Quality of Life (PeLTQL) in children between 8-17 years who underwent LTx (1.4 [0.8–3.3] years) at least one year prior to assessment. Demographic, medical, anthropometric, and HRQOL data (self-reported and parent proxy) were retrospectively collected over four years (2014–2017) at annual LTx clinic visits. The study included 35 patients (18M, 17F) and their parents/guardians. Parent-proxy and child PeLTQL scores (total, subdomain) showed good to excellent agreement (p > 0.05) and did not change over four years (p > 0.05). Younger age (<12 years) and Caucasian ancestry were associated with higher parental and self-reported perceptions of HRQOL, respectively (future health, coping and adjustment, total scores). Parent perceived lower HRQOL in social–emotional sub-domain (p = 0.03) and the child reported lower sub-domain scores related to coping and adjustment (p = 0.04) when the child was noted to have co-morbid conditions related to mental health and neurocognitive development (25.7%). While child–parent perceptions of HRQOL in a multi-ethnic population of pediatric LTx recipients remain unchanged 10 years post-LTx, adolescents of non-Caucasian ancestry remain a population at risk for lower HRQOL.
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Affiliation(s)
- Amber Hager
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, AB T6G 2E1, Canada; (A.H.); (D.M.)
| | - Diana Mager
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, AB T6G 2E1, Canada; (A.H.); (D.M.)
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada;
| | - Cheri Robert
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada;
| | - David Nicholas
- Department of Social Work, University of Calgary, Calgary, AB T5J 4P6, Canada;
| | - Susan Gilmour
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada;
- Division of Pediatric Gastroenterology & Nutrition/Transplant Services, The Stollery Children’s Hospital, Alberta Health Services, Edmonton, AB T6G 1C9, Canada
- Correspondence: ; Tel.: +1-780-248-5410
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Comparison of Quality of Life and Caregiving Burden of 2- to 4-Year-Old Children Post Liver Transplant and Their Parents. Gastroenterol Nurs 2020; 43:310-316. [PMID: 32740021 DOI: 10.1097/sga.0000000000000448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A literature search determined there are no studies on children between 2 and 4 years of age who have had a liver transplant and their parents. For this reason, this study aimed to compare the quality of life of children between 2 and 4 years of age who have had a liver transplant, and the caregiving burden of their parents. The study was carried out as a descriptive cross-sectional study on 47 children who visited Inonu University Liver Transplant Institute outpatient clinic between March 2017 and March 2018. This study found that 59.6% of the children with transplants were male and 38.3% had their organ donated by their mother. There was a positive relationship between the quality of life of the parents and the quality of life and subdimensions of the children. There was a negative relationship between parental quality of life and care burden. This study found that the quality of life of children with liver transplants and their parents was low and, as the quality of life of children was impaired, the caregiving burden of parents increased. Healthcare professionals' awareness of the effect of caregivers' care load on quality of life after liver transplantation can positively affect the healing process.
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13
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Cephus CE, Qureshi AM, Sexson Tejtel SK, Alam M, Moodie DS. Coronary artery disease in a child with homozygous familial hypercholesterolemia: Regression after liver transplantation. J Clin Lipidol 2019; 13:880-886. [PMID: 31704104 DOI: 10.1016/j.jacl.2019.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/08/2019] [Accepted: 09/17/2019] [Indexed: 11/26/2022]
Abstract
Children with homozygous familial hypercholesterolemia are at risk for early cardiovascular events secondary to coronary artery disease. Current medical therapy does not ameliorate this risk. Liver transplantation offers the most effective option to reduce circulating levels of low-density lipoprotein cholesterol and thereby reduce risk of cardiovascular events. Angiographic evidence of regression of coronary artery disease is presented.
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Affiliation(s)
- Constance E Cephus
- Texas Children's Hospital Heart Center, Pediatric Cardiology, Houston, TX; Department of Pediatrics, Baylor College of Medicine, Houston, TX.
| | - Athar M Qureshi
- Texas Children's Hospital Heart Center, Pediatric Cardiology, Houston, TX; Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - S Kristen Sexson Tejtel
- Texas Children's Hospital Heart Center, Pediatric Cardiology, Houston, TX; Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Mahboob Alam
- Margaret M and Albert B Alkek Department of Medicine, Cardiology, Baylor College of Medicine, Houston, TX
| | - Douglas S Moodie
- Texas Children's Hospital Heart Center, Pediatric Cardiology, Houston, TX; Department of Pediatrics, Baylor College of Medicine, Houston, TX
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14
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Bos GJFJ, Lelieveld OTHM, Scheenstra R, Sauer PJJ, Geertzen JHB, Dijkstra PU. Physical activity and aerobic fitness in children after liver transplantation. Pediatr Transplant 2019; 23:e13465. [PMID: 31169339 DOI: 10.1111/petr.13465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/09/2019] [Accepted: 03/31/2019] [Indexed: 11/27/2022]
Abstract
To determine physical activity (PA), aerobic fitness, muscle strength, health-related quality of life (HRQOL), fatigue, and participation in children after liver transplantation. Children, 6-12 years, at least one year after liver transplantation, participated in this cross-sectional study. Measurements: Time spent in moderate to vigorous PA (MVPA) was measured using an accelerometer, and aerobic fitness (VO2 peak ) was measured by cardiopulmonary exercise testing. Muscle strength was measured by hand-held dynamometry. Fatigue was measured using the multidimensional fatigue scale, and HRQOL with the Pediatric Quality of life Core scales and leisure activities was measured using the Children's Assessment of Participation and Enjoyment. Outcomes (medians and interquartile range (IQR)) were compared to norm values. Twenty-six children participated in this study (14 boys, age 9.7 years, IQR 7.7;11.4). Children spent 0.8 hours/d (IQR 0.6;1.1) on MVPA. One child met the recommendation of at least 1 hour of MVPA every day of the week. Aerobic fitness was similar to norms (VO2 peak 1.4 L/min , IQR 1.1;1.7, Z-score -0.3). Z-scores of muscle strength ranged between -1.4 and -0.4 and HRQOL and fatigue between -2.3 and -0.4. Participation was similar to published norms (Z-scores between -0.6 and 0.6). Young children after liver transplantation have similar MVPA patterns and aerobic fitness compared to published norms. Despite lower HRQOL, more fatigue, and less muscle strength, these children have similar participation in daily activities. Although children do well, it remains important to stimulate PA in children after liver transplantation in the context of long-term management.
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Affiliation(s)
- G J F Joyce Bos
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Otto T H M Lelieveld
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rene Scheenstra
- Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Pieter J J Sauer
- Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan H B Geertzen
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Pieter U Dijkstra
- Department of Rehabilitation Medicine, Department of Oral and Maxillofacial surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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15
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A Comparison of Caregiving Burden and Social Support Levels of Parents of Children Undergoing Liver Transplant. J Pediatr Nurs 2019; 47:e45-e50. [PMID: 31064678 DOI: 10.1016/j.pedn.2019.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 04/20/2019] [Accepted: 04/20/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE This study was conducted to compare caregiving burden and social support levels of parents of children who have undergone a liver transplant. DESIGNS AND METHODS This study utilized a descriptive, cross-sectional research design. Data were collected using a parent information form, the Zarit Burden Interview, and the Multidimensional Scale of Perceived Social Support. Data were collected via face-to-face interview after written consent was obtained from the parents of children who had received a liver transplant. RESULTS Parent participants were found to have a high caregiving burden and low levels of social support from their surroundings. Parents who experienced change in their work life, social and family relationships, and had economic problems post-transplant, had a higher caregiving burden and may have lower social support. Parents whose children had a transplant from a cadaveric donor and continued to attend school were found to have a lower caregiving burden. There was a negative correlation between parent caregiving burden and social support scores; that is, caregiving burden (R2 = 0.57, p < 0.01) was significantly affected by social support (B = -0.682, β = -0.757). CONCLUSIONS This study concluded that parents receiving social support may have a lower caregiving burden, and some of their socio-demographic characteristics may have a positive effect on social support and caregiving burden. PRACTICE IMPLICATIONS Health professionals need to pay special attention to the social support and caregiving burden of parents whose children have had an organ transplant.
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Aston J, Wilson KA, Terry DRP. The treatment-related experiences of parents, children and young people with regular prescribed medication. Int J Clin Pharm 2018; 41:113-121. [PMID: 30478490 PMCID: PMC6394506 DOI: 10.1007/s11096-018-0756-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 11/15/2018] [Indexed: 01/20/2023]
Abstract
Background Taking regular medication has been shown to have an impact on the daily lives of patients and their families. Objective To explore the medication-related experiences of patients and their families when a child or young person is prescribed regular medication. Setting A specialist U.K. paediatric hospital. Method Semi-structured face-to-face interviews of 24 parents/carers, children or young people, who had been taking two or more medications for 6 weeks or longer. The themes explored included the medication regimen, formulation, supplies, social aspects and adverse effects. The data was analysed using NVIVO version 11. Main outcome measure The experiences of patients, and their parents/carers, when a child/young person takes regular medication. Results Participants described a range of experiences associated with taking regular medication. Medication-related challenges were experienced around the timing of administration which was managed over 24 h rather than waking hours. Updating medication doses for administration at school was often delayed. Unintended nonadherence was cited as the biggest challenge with a range of strategies employed to manage this. The internet was commonly used as a source of additional information accessed for reassurance and adverse effects but there were varying experiences of using patient forums/help groups. Other challenges included the adequacy of information, travelling with medication, formulation issues, arranging supplies and adverse effects. Conclusion Patients and parents experience many challenges with children’s medication. Individualised treatment options should be considered. Further research is required to determine how these experiences may be managed including the role of paediatric medication review.
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Affiliation(s)
- Jeff Aston
- Aston Pharmacy School, Aston University, Birmingham, UK. .,Pharmacy Department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
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The Adaptation and Psychometric Properties of the Kid-KINDL R for Hospitalized Children in Chile. J Pediatr Nurs 2018; 41:e8-e15. [PMID: 29477451 DOI: 10.1016/j.pedn.2018.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE The impact of hospitalization on a child's well-being leads one to consider the health-related quality of life (HRQoL) measure as a fundamental aspect of pediatric care. The aims of the study were to adapt the Spanish version of the Kid-KINDL® to hospitalized children in Chile, to obtain a reduced version of the instrument and to analyze the psychometric properties of the reduced version. DESIGN AND METHODS An expert committee and interviews were carried out for the cross-cultural adaptation process. An exploratory factor analysis was conducted to examine the validity of the construct and to select the items for the reduced version. Cronbach's alpha was used to estimate the internal consistency of the adapted version of the Kid-KINDL® and the reliability of each component. Convergent validity was based on correlations with a pain scale. RESULTS This adapted and shorter instrument, similar to the original version, comprises five components that include the principal dimensions of HRQoL. Evaluating the School dimension in hospitalized children was considered inappropriate in Chilean public hospitals. The study replicates the relationship found between a child with high pain and low reported HRQoL. CONCLUSIONS The hospitalization process impacted the children's perceptions of their HRQoL. The reduced version of the Kid-KINDL® was found to be a valid instrument for assessing children's HRQoL in hospital units. PRACTICE IMPLICATIONS Finding effective ways to measure HRQoL and ultimately mitigate barriers and foster resilience are important clinical and research priorities in the pursuit of HRQoL for hospitalized children and their families.
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Patterson C, So S, DeAngelis M, Ghent E, Southmayd D, Carpenter C. Physical activity experiences in children post-liver transplant: Developing a foundation for rehabilitation interventions. Pediatr Transplant 2018; 22:e13179. [PMID: 29575295 DOI: 10.1111/petr.13179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 12/26/2022]
Abstract
Physical Activity (PA) plays an important role in the physical and psychosocial health of children and is beneficial in the treatment and prevention of comorbidities associated with transplantation. Despite this, PA participation in pediatric liver transplant recipients remains low compared to healthy peers. This qualitative-focused mixed-methods study explored the PA experiences and parental perception of these experiences, including perceived facilitators and barriers to PA in children post-liver transplant. Eighteen participants (9 children [median age 10.8 years] and 9 parents) took part in semi-structured interviews and completed the PedsQL Multidimensional Fatigue Scale and PAQ. Most children reported they were physically active (PAQ median 3.08 [IQR] 2.60-3.51), participating in PA for its enjoyment, regardless of their level of motor proficiency. Levels of fatigue (median 65.28 [IQR] 56.25-90.97) were higher than healthy norms and impacted PA participation in some children. Children and parents perceived PA as central to post-transplant recovery and valued its social and mental health benefits; however, parents struggled with ongoing uncertainty and perceived physical vulnerability of their child. This study indicates the need for continuing PA support and education and provides valuable information for family-centered interventions to increase PA and improve health outcomes in children post-transplant.
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Affiliation(s)
- Catherine Patterson
- Rehabilitation Medicine, Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Stephanie So
- Rehabilitation Medicine, Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Maria DeAngelis
- Department of Pediatrics, Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Emily Ghent
- Department of Social Work, Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Degen Southmayd
- Rehabilitation Medicine, Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Christine Carpenter
- Graduate Department of Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
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Parmar A, Vandriel SM, Ng VL. Health-related quality of life after pediatric liver transplantation: A systematic review. Liver Transpl 2017; 23:361-374. [PMID: 28006876 DOI: 10.1002/lt.24696] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 11/26/2016] [Indexed: 12/15/2022]
Abstract
With improved survival rates after pediatric liver transplantation (LT), attention is targeting improving the health-related quality of life (HRQOL) as an outcome metric. We conducted a systematic review of the literature to examine HRQOL after pediatric LT, focusing on assessment tools and factors associated with HRQOL. A literature search was conducted through PubMed, Web of Science, Ovid, and Google Scholar for all studies matching the eligibility criteria between January 2004 and September 2016. Titles and abstracts were screened independently by 2 authors and consensus for included studies was achieved through discussion. A total of 25 (2 longitudinal, 23 cross-sectional) studies were reviewed. HRQOL in pediatric LT recipients is lower than healthy controls, but it is comparable to children with chronic diseases or other pediatric solid organ transplant recipients. Domain scores were lowest in school functioning on the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scale 4.0 and general health perception on the Child Health Questionnaire, the 2 most commonly used generic HRQOL instruments. Identified predictors of poor HRQOL include sleep disturbances, medication adherence, and older age at transplantation. Two recently validated disease-specific HRQOL tools, Pediatric Liver Transplant Quality of Life tool and the Pediatric Quality of Life Inventory 3.0 Transplant Module, have enabled enhanced representation of patient HRQOL, when used in conjugation with generic tools. Heterogeneity in study design and instruments prevented a quantitative, meta-analysis of the data. In conclusion, continued optimization of durable outcomes for this population mandates prioritization of research focusing on the gap of targeted intervention studies aimed at specific HRQOL subdomains and longitudinal studies to predict the trajectory of HRQOL over time. Liver Transplantation 23 361-374 2017 AASLD.
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Affiliation(s)
- Arpita Parmar
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Transplant and Regenerative Medicine Center, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Shannon Marie Vandriel
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Transplant and Regenerative Medicine Center, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Vicky Lee Ng
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, Transplant and Regenerative Medicine Center, The Hospital for Sick Children, University of Toronto, Ontario, Canada
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Health-Related Quality of Life after Pediatric Liver Transplantation: A Qualitative Analysis of the Perspectives of Health Care Providers. Can J Gastroenterol Hepatol 2017; 2017:5274923. [PMID: 28713797 PMCID: PMC5496102 DOI: 10.1155/2017/5274923] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/28/2017] [Indexed: 11/19/2022] Open
Abstract
With improved survival outcomes after pediatric liver transplantation (LT), health-related quality of life (HRQoL) is an important outcome metric. Understanding the elements contributing to HRQoL after LT in children would enable more targeted strategies towards optimizing best outcomes. This qualitative study aimed to explore health care providers (HCP) perceptions about HRQoL after pediatric LT. Thirteen experienced HCP participated in two focus group discussions. Data analysis via a thematic analysis approach revealed 4 major themes: "LT as a facilitator of better HRQoL," "coping and adapting to LT," "living with a transplanted liver," and "the family context." HCP identified elements that both enhance (improved physical health, peer relationship, and activities of daily living) and challenge (need for immunosuppression, transplant follow-up, and restrictions) the multidimensional domains of HRQoL. HCP perceived LT to be a stressful life-changing event for children and their families. Patients and their parents' ability to cope and adjust positively to LT was perceived as a key contributor to better HRQoL. HCP perspective highlights the importance of promoting psychosocial support and a family-centered care delivery model towards the overarching goal of optimizing durable outcomes.
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Abstract
Liver transplantation (LT) is an important component in the therapeutic armamentarium of managing end-stage liver disease. In North American children, biliary atresia remains the most common indication for LT compared to hepatitis C in adults, while hepatoblastoma is the most common liver tumor requiring LT, versus Hepatocellular carcinoma in adults. Rejection, lymphoproliferative disease, renal insufficiency, metabolic syndrome, recurrent disease, 'de novo' autoimmune hepatitis and malignancy require careful surveillance and prompt action in adults and children after LT. In children, specific attention to EBV viremia, growth, development, adherence and transition to the adult services is also required. Antibody mediated rejection and screening for donor specific antibodies is becoming important in managing liver graft dysfunction. Biomarkers to identify and predict tolerance are being developed. Machine perfusion and stem cells (iPS) to synthesize organs are generating interest and are a focus for research.
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Affiliation(s)
- Nanda Kerkar
- a Keck School of Medicine, Medical Director Liver/Intestinal and Hepatology Transplant Program, Children's Hospital of Los Angeles , University of Southern California , Los Angeles , CA , USA
| | - Arathi Lakhole
- b Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Los Angeles , University of Southern California , Los Angeles , CA , USA
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Fredericks EM, Zelikovsky N, Aujoulat I, Hames A, Wray J. Post-transplant adjustment--the later years. Pediatr Transplant 2014; 18:675-88. [PMID: 25220845 PMCID: PMC4179879 DOI: 10.1111/petr.12366] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2014] [Indexed: 01/04/2023]
Abstract
As survival rates for pediatric solid organ transplantation have continued to improve, researchers and healthcare providers have increasingly focused on understanding and enhancing the HRQOL and psychosocial functioning of their patients. This manuscript reviews the psychosocial functioning of pediatric transplant recipients during the "later years," defined as more than three yr post-transplant, and focuses on the day-to-day impact of living with a transplant after the immediate period of adjustment and early years after surgery. Key topics reviewed include HRQOL, cognitive functioning, impact on the family, regimen adherence, and transition of responsibility for self-management tasks. Overall, pediatric transplant recipients evidence impairment in HRQOL, neuropsychological outcomes, and family functioning as compared to non-transplant recipients. However, the degree of impairment is influenced by a variety of factors including, disease severity, age, solid organ type, and study methodologies. Studies are limited by small samples, cross-sectional design, and the lack of universal assessment battery to allow for comparisons across solid organ populations. Areas for future research are discussed.
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Affiliation(s)
- Emily M. Fredericks
- Department of Pediatrics, University of Michigan and C.S. Mott Children’s Hospital
| | - Nataliya Zelikovsky
- Department of Psychology, La Salle University and The Children’s Hospital of Philadelphia
| | - Isabelle Aujoulat
- Université Catholique de Louvain, Institute of Health & Society (IRSS), Brussels, Belgium
| | - Anna Hames
- Institute of Liver Studies, King’s College Hospital, London UK
| | - Jo Wray
- Critical Care and Cardiorespiratory Division, Great Ormond Street Hospital for Children, London UK
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Development and validation of the pediatric liver transplantation quality of life: a disease-specific quality of life measure for pediatric liver transplant recipients. J Pediatr 2014; 165:547-55.e7. [PMID: 24976329 DOI: 10.1016/j.jpeds.2014.05.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/03/2014] [Accepted: 05/12/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To develop and validate a Pediatric Liver Transplantation Quality of Life (PeLTQL) questionnaire via an international multicenter collaboration. STUDY DESIGN Item generation with 146 child and/or parent interviews (92 pediatric liver transplantation [LT] recipients) and 3 focus groups generated over 300 items. An item reduction questionnaire with 76 questions was completed by 320 participants (212 pediatric LT recipients). RESULTS Frequency-importance product ranking, questionnaire formatting, and pre-testing resulted in a 26-item PeLTQL questionnaire. Factor analysis identified 3 domains: future health, coping and adjustment, and social-emotional. The validation phase was completed by 133 (46% male) LT recipients (aged 8-18 years). Internal consistency (Cronbach α = 0.86) and test-retest reliability (intraclass correlation coefficient = 0.85) were excellent. Mean patient PeLTQL score was 69.54 ± 13.06. Construct validity with validated tools identified significant correlations between mean PeLTQL scores and (1) Pediatric Quality of Life Inventory generic (r = 0.64, P < .001); (2) Pediatric Quality of Life Inventory transplant (r = 0.73, P < .001); and (3) Screen for Child Anxiety Related Disorders (r = -0.57, P < .001) scores. Only 17/3458 (0.5%) questions were left blank. A Flesch-Kincaid grade level of 5.4 was calculated as a measure of the PeLTQL readability statistic. CONCLUSIONS The PeLTQL is a valid and reliable novel 26-item disease-specific health related quality of life instrument for LT recipients aged 8-18 years. Low PeLTQL scores can identify patients at risk for childhood anxiety and depression. The tool is now ready for broad use in both clinical practice and clinical interventional trials.
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Annunziato RA, Parbhakar M, Helcer J, Kapoor K, Henkel K, Arnon R. Strategies for Measuring Quality of Life among Pediatric Solid-Organ Transplant Recipients. Prog Transplant 2014; 24:247-56. [DOI: 10.7182/pit2014171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective Quality of life (QoL) has become a mainstay in the outcome assessment of pediatric solid-organ transplant recipients. Yet, how QoL is operationalized and measured varies drastically. It may be very difficult for clinicians and researchers to determine which methods of QoL assessment best meet the needs of their patients or study. The purpose of this literature review is to describe and evaluate the current status of QoL measurement in studies of pediatric solid-organ transplant recipients. Data Sources Searches of PubMed and PsycINFO from January 1985 to February 2012. Study Selection English peer-reviewed publications that described a method for measuring QoL whether it was a standardized questionnaire, qualitative approach, or another way of operationalizing the construct. Data Extraction QoL measurement strategies were extracted from 43 studies that met inclusion criteria. Data Synthesis Each article was reviewed and summarized by 2 study team members. Conclusions Many different strategies were used for measurement, and some were not consistent with established conceptualizations of QoL. Overall recommendations for best practices are offered. Detailed information about specific measures is included, and measures that seem to capture the construct well are recommended. Additionally, our review highlighted the importance of using a “battery approach,” including child and parent report as well as considering other variables, such as patient's age, when selecting a QoL measurement strategy.
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Affiliation(s)
- Rachel A. Annunziato
- Fordham University, Bronx, New York (RAA, MP, JH, KH), Icahn School of Medicine at Mount Sinai, New York (KK, RA)
| | - Meera Parbhakar
- Fordham University, Bronx, New York (RAA, MP, JH, KH), Icahn School of Medicine at Mount Sinai, New York (KK, RA)
| | - Jacqueline Helcer
- Fordham University, Bronx, New York (RAA, MP, JH, KH), Icahn School of Medicine at Mount Sinai, New York (KK, RA)
| | - Kathryn Kapoor
- Fordham University, Bronx, New York (RAA, MP, JH, KH), Icahn School of Medicine at Mount Sinai, New York (KK, RA)
| | - Kristen Henkel
- Fordham University, Bronx, New York (RAA, MP, JH, KH), Icahn School of Medicine at Mount Sinai, New York (KK, RA)
| | - Ronen Arnon
- Fordham University, Bronx, New York (RAA, MP, JH, KH), Icahn School of Medicine at Mount Sinai, New York (KK, RA)
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25
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Lu Y, Yang Y, Wang Y, Zhao A, Han L, Chen X, Zhang J, Xia Q. Donors’ Quality of Life after Live Liver Transplantation and Social Support: A Correlation Study. Health (London) 2014. [DOI: 10.4236/health.2014.610111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Baranyi A, Krauseneck T, Rothenhäusler HB. Posttraumatic stress symptoms after solid-organ transplantation: preoperative risk factors and the impact on health-related quality of life and life satisfaction. Health Qual Life Outcomes 2013; 11:111. [PMID: 23822659 PMCID: PMC3717120 DOI: 10.1186/1477-7525-11-111] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 07/01/2013] [Indexed: 01/18/2023] Open
Abstract
Background Solid-organ transplantations (SOT) are usually life-saving high-tech medical procedures. The transplantation itself and the intensive care unit stay could be traumatic stressors triggering posttraumatic stress symptoms (PTSS). Our retrospective follow-up study aimed to explore preoperative risk factors of PTSS in a cohort of SOT recipients, and we investigated how PTSS are associated with health-related quality of life (HRQOL) and life satisfaction. Methods 126 SOT recipients were enrolled in this investigation. Psychiatric examination of all SOT candidates based on the Transplant Evaluation Rating Scale was carried out before SOT, and after SOT, recipients completed the PTSS-10, the SF-36 and the FLZ. Results After the surgical intervention 19 (15.1%) SOT recipients had clinical significant PTSS. Preoperative risk factors for developing postoperative PTSS were: 1.) preexisting psychiatric morbidity, 2.) history of retransplantation, 3.) chronic benzodiazepine consumption, 4.) age, and 5.) type of transplantation. SOT-related PTSS were associated with maximal decrements in HRQOL and life satisfaction. The following HRQOL and life satisfaction domains were affected: Physical Functioning, Role Physical, Pain, General Health, Vitality, Social Functioning, Role Emotional, Mental Health, Occupation/Work and Character/Own Skills. Conclusion SOT recipients may face a major risk of transplantation- and treatment-related PTSS and the development of impairments to HRQOL and life satisfaction.
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Affiliation(s)
- Andreas Baranyi
- Department of Psychiatry, University of Medicine of Graz, Auenbruggerplatz 31, Graz 8036, Austria.
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Williams L, Eilers J, Heermann J, Smith K. The lived experience of parents and guardians providing care for child transplant recipients. Prog Transplant 2013. [PMID: 23187058 DOI: 10.7182/pit2012907] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Little has been published about the caregiving experiences of the parents or guardians of children receiving liver or liver/intestinal transplants. OBJECTIVE To describe the lived experiences of parents and guardians as they prepared for and provided postdischarge care to a child who received an isolated intestine or a liver/intestinal transplant and to assess the impact of transplants on parents' stress levels. DESIGN Semistructured, audio-taped phone interviews of parents' and guardians' perceptions of their experiences preparing to and providing care to a child transplant recipient were transcribed verbatim and analyzed by the research team using established qualitative research methods. PARTICIPANTS Five parents or guardians (3 mothers, 1 foster mother, and 1 grandfather) of children who received a transplant between 2000 and 2008 at age 11 months to 6.7 years. RESULTS Responses to the interviews gravitated toward 3 focal points: the parents' and guardians' perceptions of their interactions with the transplant team, their interactions with the local health care systems, and caring for themselves and their child at home. CONCLUSION In preparing parents and guardians to care for their children after discharge from the hospital, transplant teams need to be aware of differences between what we think we communicate and how it is interpreted by the parents and guardians, the relationships built between parents and guardians and health care teams, parents' attitudes and levels of stress, and the impact these factors have on care and the parents' and guardians' experience.
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Baranyi A, Krauseneck T, Rothenhäusler HB. Overall mental distress and health-related quality of life after solid-organ transplantation: results from a retrospective follow-up study. Health Qual Life Outcomes 2013; 11:15. [PMID: 23391215 PMCID: PMC3579763 DOI: 10.1186/1477-7525-11-15] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 02/04/2013] [Indexed: 12/26/2022] Open
Abstract
Background Our retrospective follow-up study aimed to explore the degree of overall mental distress in a cohort of solid-organ transplantation (SOT) recipients after liver, heart or lung transplantation. Furthermore, we investigated how overall mental distress is linked to health-related quality of life. Methods 123 SOT patients treated during the study period were enrolled in this investigation at a mean of 24.6 months (SD=11.6) after transplantation. Before transplantation, the Transplant Evaluation Rating Scale (TERS) was used to classify the level of adjustment in psychosocial functioning among transplantation candidates. After transplantation, recipients completed a research battery, which included the SCL-90-R, and the SF-36. Results 39 (31.7%) transplantation recipients had clinically significant overall mental distress as measured on the Global Severity Index of the SCL-90-R. Obsessive-compulsive symptoms (92.3%), somatization symptoms (87.2%), anxiety symptoms (84.6%), depression symptoms (82.1%) and phobic anxiety symptoms (69.2%) were a frequent finding. Transplantation recipients with overall mental distress had significant lower levels of adjustment in psychosocial functioning before transaplantation than those without overall mental distress as measured in the TERS. Transplantation-related overall mental distress symptomatology was associated with maximal decrements in health-related quality of life. Conclusion Transplantation recipients may face major transplantation- and treatment-related overall mental distress and impairments to their health-related quality of life. Further, overall mental distress is a high-risk factor in intensifying impairments to patients’ overall quality of life.
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Affiliation(s)
- Andreas Baranyi
- Department of Psychiatry, University of Medicine of Graz, Auenbruggerplatz 31, 8036, Graz, Austria.
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Roblin E, Audhuy F, Boillot O, Rivet C, Lachaux A. Qualité de vie à long terme après transplantation hépatique chez l’enfant. Arch Pediatr 2012; 19:1039-52. [DOI: 10.1016/j.arcped.2012.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 04/21/2012] [Accepted: 06/29/2012] [Indexed: 10/26/2022]
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Wang GS, Yang Y, Li H, Jiang N, Fu BS, Jin H, Yang JX, Chen GH. Health-related quality of life after liver transplantation: the experience from a single Chinese center. Hepatobiliary Pancreat Dis Int 2012; 11:262-6. [PMID: 22672819 DOI: 10.1016/s1499-3872(12)60158-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Few studies have been performed to assess health-related quality of life (HRQOL) in liver transplantation (LT) patients in the mainland of China. This study aimed to investigate the HRQOL of post-LT patients in a single center. METHODS HRQOL was evaluated by the SF-36 (Chinese version) questionnaire in 60 patients (LT group) who had received LT for benign end-stage liver disease (BELD). Fifty-five patients with BELD (BELD group) and 50 healthy volunteers from the general population (GP group) were also evaluated, and the results were compared among the three groups. RESULTS There was a significant difference among the three groups in terms of the scores of eight domains in the SF-36 (P<0.01). Patients in the BELD group had lower scores in each domain of the SF-36 in comparison with those in the GP group (P<0.025). The LT group had mental health scores equivalent to those of the BELD group (P>0.025), but higher scores for the remaining seven domains (P<0.025). Compared with the GP group, the LT group scored equivalently for role physical, body pain, vitality, social function and role emotion (P>0.025), but had lower scores for the remaining three domains (P<0.025). Lower family income was found to be associated with reduced physical function and mental health scores (P<0.05). Better education was associated with increased mental health scores (P<0.05). CONCLUSIONS LT patients generally have a good HRQOL although some respects of their HRQOL remains to be improved. Lower family income and poor education are important factors relating to the poor HRQOL of LT patients.
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Affiliation(s)
- Gen-Shu Wang
- Department of Hepatic Surgery and Liver Transplant Center, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
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Ng VL, Alonso EM, Bucuvalas JC, Cohen G, Limbers CA, Varni JW, Mazariegos G, Magee J, McDiarmid SV, Anand R. Health status of children alive 10 years after pediatric liver transplantation performed in the US and Canada: report of the studies of pediatric liver transplantation experience. J Pediatr 2012; 160:820-6.e3. [PMID: 22192813 PMCID: PMC4144332 DOI: 10.1016/j.jpeds.2011.10.038] [Citation(s) in RCA: 185] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 08/12/2011] [Accepted: 10/27/2011] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To determine clinical and health-related quality of life outcomes, and to derive an "ideal" composite profile of children alive 10 years after pediatric liver transplantation (LT) performed in the US and Canada. STUDY DESIGN This was a multicenter cross-sectional analysis characterizing patients enrolled in the Studies of Pediatric Liver Transplantation database registry who have survived >10 years from LT. RESULTS A total of 167 10-year survivors were identified, all of whom received daily immunosuppression therapy. Comorbidities associated with the post-LT course included post-transplantation lymphoproliferative disease (in 5% of patients), renal dysfunction (9%), and impaired linear growth (23%). Health-related quality of life, as assessed by the PedsQL 4.0 Generic Core Scales, revealed lower patient self-reported total scale scores for 10-year survivors compared with matched healthy children (77.2±12.9 vs 84.9±11.7; P<.001). At 10 years post-LT, only 32% of patients achieved an ideal profile of a first allograft stable on immunosuppression monotherapy, normal growth, and absence of common immunosuppression-induced sequelae. CONCLUSION Success after pediatric LT has moved beyond patient survival. Availability of an ideal composite profile at follow-up provides opportunities for patients, families, and healthcare providers to identify broader sets of outcomes at earlier stages, ultimately contributing to improved outcomes after pediatric LT.
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Affiliation(s)
- Vicky L. Ng
- SickKids Transplant Center, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Estella M. Alonso
- Siragusa Transplant Center, Children’s Memorial Hospital and Northwestern University Feinberg School of Medicine, Chicago, IL
| | - John C. Bucuvalas
- Pediatric Liver Care Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | | | - James W. Varni
- Departments of Pediatrics and Landscape Architecture and Urban Planning, Texas A&M University, College Station, TX
| | - George Mazariegos
- Hillman Center for Pediatric Transplantation, Children’s Hospital of Pittsburgh and Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - John Magee
- Division of Transplantation, University of Michigan Health System, Ann Arbor, MI
| | - Susan V. McDiarmid
- Dumont–University of California Los Angeles Liver Transplant Center, UCLA School of Medicine and Mattel Children’s Hospital, Los Angeles, CA
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Abstract
Liver transplantation is the standard of care for children with life-threatening liver disease. Survival rates posttransplantation are rising with current 1-year and 5-year rates being greater than 90% and 85%, respectively. Numerous factors contribute to posttransplant outcomes of graft and patient survival, including improved surgical techniques, immunosuppressive regimens, and posttransplant management. The present review aims to discuss predictors of long-term outcomes of pediatric transplant recipients and identify potential risk factors.
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