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Traunwieser T, Loos E, Ottensmeier H, Gastberger K, Nemes K, Mynarek M, Bison B, Kandels D, Neumayer P, Neumann-Holbeck A, Lüttich P, Baust K, Faulstich-Ritter K, John R, Kreisch A, Landmann J, Manteufel E, Nest A, Prüfe J, Schubert L, Stamm W, Timmermann B, Gerss J, Rutkowski S, Schlegel PG, Eyrich M, Gnekow AK, Frühwald MC. Survivors of infant atypical teratoid/rhabdoid tumors present with severely impaired cognitive functions especially for fluid intelligence and visual processing: data from the German brain tumor studies. Pediatr Blood Cancer 2024; 71:e30910. [PMID: 38342954 DOI: 10.1002/pbc.30910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/12/2024] [Accepted: 01/23/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND The contribution of tumor type, multimodal treatment, and other patient-related factors upon long-term cognitive sequelae in infant brain tumor survivors remains undefined. We add our retrospective analysis of neuropsychological and quality of survival (QoS) outcome data of survivors of atypical teratoid/rhabdoid tumors (ATRT) and extracranial malignant rhabdoid tumors of the soft tissues (eMRT) and kidneys (RTK) treated within the same framework. Neuropsychological data from children with ATRT were compared to data from children with non-irradiated low-grade glioma (LGG). PATIENTS AND METHODS Following surgery, patients (0-36 months at diagnosis) had received radio-chemotherapy (up to 54 Gy; ATRT: n = 13; eMRT/RTK: n = 7), chemotherapy only (LGG: n = 4; eMRT/RTK: n = 1) or had been observed (LGG: n = 11). Neuropsychological evaluation employing comparable tests was performed at median 6.8 years (ATRT), 6.6 years (eMRT/RTK), and 5.2 years (LGG) post diagnosis. RESULTS We detected sequelae in various domains for all tumor types. Group comparison showed impairments, specifically in fluid intelligence (p = .041; d = 1.11) and visual processing (p = .001; d = 2.09) in ATRT patients when compared to LGG patients. Results for psychomotor speed and attention abilities were significantly below the norm for both groups (p < .001-.019; d = 0.79-1.90). Diagnosis predicted impairments of cognitive outcome, while sex- and age-related variables did not. QoS outcome for all rhabdoid patients displayed impairments mainly in social (p = .008; d = 0.74) and school functioning (p = .048; d = 0.67), as well as lower overall scores in psychosocial functioning (p = .023; d = 0.78) and quality of life (p = .006; d = 0.79) compared to healthy controls. CONCLUSION Survivors of infant ATRT experience various late effects in cognition and QoS following multimodal treatment, while infant LGG patients without radiotherapy demonstrated comparable impairments in psychomotor and attention abilities. Early onset and multimodal treatment of rhabdoid tumors require close monitoring of neuropsychological and QoS sequelae.
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Affiliation(s)
- Thomas Traunwieser
- Swabian Children's Cancer Center, Pediatrics and Adolescent Medicine, University Hospital Augsburg, Augsburg, Germany
- Bavarian Cancer Research Center, Augsburg, Germany
| | - Elena Loos
- Swabian Children's Cancer Center, Pediatrics and Adolescent Medicine, University Hospital Augsburg, Augsburg, Germany
- Bavarian Cancer Research Center, Augsburg, Germany
| | - Holger Ottensmeier
- Department of Pediatric Hematology and Oncology, University Hospital Würzburg, Würzburg, Germany
| | - Katharina Gastberger
- Swabian Children's Cancer Center, Pediatrics and Adolescent Medicine, University Hospital Augsburg, Augsburg, Germany
- Bavarian Cancer Research Center, Augsburg, Germany
| | - Karolina Nemes
- Swabian Children's Cancer Center, Pediatrics and Adolescent Medicine, University Hospital Augsburg, Augsburg, Germany
- Bavarian Cancer Research Center, Augsburg, Germany
| | - Martin Mynarek
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Brigitte Bison
- Diagnostic and Interventional Neuroradiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Neuroradiological Reference Center for the Pediatric Brain Tumor (HIT) Studies of the German Society of Pediatric Oncology and Hematology, Faculty of Medicine, University Augsburg, Augsburg, Germany
| | - Daniela Kandels
- Swabian Children's Cancer Center, Pediatrics and Adolescent Medicine, University Hospital Augsburg, Augsburg, Germany
- Bavarian Cancer Research Center, Augsburg, Germany
| | - Petra Neumayer
- Swabian Children's Cancer Center, Pediatrics and Adolescent Medicine, University Hospital Augsburg, Augsburg, Germany
- Bavarian Cancer Research Center, Augsburg, Germany
| | - Anne Neumann-Holbeck
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Peggy Lüttich
- Hopp Children's Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ) and Heidelberg, University Hospital, Heidelberg, Germany
| | - Katja Baust
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | | | - Rainer John
- Department Pediatric Hematology and Oncology, Center for Chronically Sick Children (SPZ), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andrea Kreisch
- Department of Pediatrics, University Hospital and Medical Faculty Carl-Gustav-Carus, Technische Universität Dresden, Dresden, Germany
| | - Judyta Landmann
- Department of Paediatric Haematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Eva Manteufel
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Justus-Liebig University of Giessen, Giessen, Germany
| | - Alexandra Nest
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Jenny Prüfe
- Department of Pediatric Hematology and Oncology, Pediatrics III, Essen University Hospital, Essen, Germany
| | - Lisa Schubert
- Department of Pediatric Hematology and Oncology, University Hospital Würzburg, Würzburg, Germany
| | - Walther Stamm
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), Essen, Germany
| | - Joachim Gerss
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Paul-Gerhardt Schlegel
- Department of Pediatric Hematology and Oncology, University Hospital Würzburg, Würzburg, Germany
| | - Matthias Eyrich
- Department of Pediatric Hematology and Oncology, University Hospital Würzburg, Würzburg, Germany
| | - Astrid K Gnekow
- Swabian Children's Cancer Center, Pediatrics and Adolescent Medicine, University Hospital Augsburg, Augsburg, Germany
- Bavarian Cancer Research Center, Augsburg, Germany
| | - Michael C Frühwald
- Swabian Children's Cancer Center, Pediatrics and Adolescent Medicine, University Hospital Augsburg, Augsburg, Germany
- Bavarian Cancer Research Center, Augsburg, Germany
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Prüfe J. Decision Making in the Context of Paediatric Solid Organ Transplantation Medicine. Transpl Int 2022; 35:10625. [PMID: 35911781 PMCID: PMC9329518 DOI: 10.3389/ti.2022.10625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022]
Abstract
This manuscript aims to outline ethical, legal, and psychosocial key situations in the context of transplantation under special consideration of children. Besides being particularly vulnerable, children as minors by law are not meant to consent to whatever medical procedure is applied to them. Rather their next-of-kin and medical staff are to decide. In the context of transplantation thus it needs to be reflected under which circumstances a child can become an organ donor or receive an organ. This essay will not provide answers to current questions in transplantation medicine but provide an overview of present European practices and juxtapose divergent courses of action which are based on an assumed similar social-cultural background. Data are drawn from a systematic comparison of the various national organ transplantation laws and tissue acts. Ethical reflections are based on a thematically targeted literature search using PubMed Central and PhilPapers databases.
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Traunwieser T, Loos E, Nemes K, Kandels D, Neumayer P, Neumann-Holbeck A, Lüttich P, Baust K, Faulstich-Ritter K, John R, Kreisch A, Manteufel E, Nest A, Prüfe J, Schubert L, Siebrands J, Stamm W, Timmermann B, Gerss J, Gnekow AK, Frühwald MC. ATRT-02. Neuropsychological function in infant atypical teratoid/rhabdoid tumor versus low-grade glioma survivors reflects tumor malignancy and multimodal treatment. Neuro Oncol 2022. [PMCID: PMC9164638 DOI: 10.1093/neuonc/noac079.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND: Therapy of infants with brain tumors predisposes these patients to increased risks for cognitive sequelae, especially following radiotherapy. Neuropsychological outcome gains importance for those 40-60% of patients with an atypical teratoid/rhabdoid tumor (ATRT) who survive beyond 2 years. Still, reports on cognitive late-effects in children with ATRT are scarce compared to other pediatric brain tumor groups. We analyzed neuropsychological outcome for long-term ATRT-survivors registered in EU-RHAB and infant low-grade glioma (LGG) survivors from the SIOP-LGG 2004-study and LGG-registry. PATIENTS+METHODS: Age at diagnosis of both cohorts was 0-36 months. ATRT-patients (n=13) treated with up to 54Gy radiotherapy (median age 22 months (±7.1)) were evaluated with the “ATRT-Neuropsychology” tool based on SIOPE-BTG QoS-Group recommendations at median 6.8 years (±2.8) after diagnosis. LGG-patients (n=15) treated without radiotherapy (4/15 with chemotherapy) were analyzed with the German “Neuropsychological-Basic-Diagnostic” tool 5.2 years (±0.6) post-diagnosis. RESULTS: The ATRT- vs. LGG-cohorts were comparable for median age at diagnosis, sex-ratio and tumor-localization, though they differed slightly in median age at assessment (9.5/7.2 years (±2.5/1.1)). Results of age-appropriate tests showed increased impairments for ATRT-patients in fluid intelligence (FI) (p=.006, d=1.214) and in visual-spatial processing (VSP) (p<.001, d=2.233) compared to LGG-patients. The median for neuropsychological test results of ATRT-patients spanned from considerably below the normal to the lower normal range (median=65-90), while results of LGG-patients were mostly in the lower normal range (median=83-103). Results for psychomotor speed abilities (PMS) were distinctly below the norm for both patient groups (p=.002-.007). CONCLUSION: Infant ATRT- and LGG-patients develop significant impairments in PMS abilities following multimodal treatment. Long-term survivors of ATRT suffer from additional FI and VSP deficits. Our data suggest that high malignancy requiring multimodal treatment determines the inferior cognitive outcome for the ATRT-cohort. Long-term neuropsychological monitoring (and treatment options) should be implemented as standard of care in ATRT- and LGG-trials.
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Affiliation(s)
- Thomas Traunwieser
- Swabian Children’s Cancer Research Center, Pediatric and Adolescent Medicine, Medical Faculty, University of Augsburg , Augsburg , Germany
| | - Elena Loos
- Swabian Children’s Cancer Research Center, Pediatric and Adolescent Medicine, Medical Faculty, University of Augsburg , Augsburg , Germany
| | - Karolina Nemes
- Swabian Children’s Cancer Research Center, Pediatric and Adolescent Medicine, Medical Faculty, University of Augsburg , Augsburg , Germany
| | - Daniela Kandels
- Swabian Children’s Cancer Research Center, Pediatric and Adolescent Medicine, Medical Faculty, University of Augsburg , Augsburg , Germany
| | - Petra Neumayer
- Swabian Children’s Cancer Research Center, Pediatric and Adolescent Medicine, Medical Faculty, University of Augsburg , Augsburg , Germany
| | - Anne Neumann-Holbeck
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg Eppendorf , Hamburg , Germany
| | - Peggy Lüttich
- Hopp Children’s Cancer Center Heidelberg (KiTZ), German Cancer Research Center (DKFZ) and Heidelberg University Hospital , Heidelberg , Germany
| | - Katja Baust
- Department of Pediatric Hematology and Oncology, University Hospital Bonn , Bonn , Germany
| | | | - Rainer John
- Center for Chronically Sick Children (SPZ) Department Pediatric Hematology and Oncology; Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin , Berlin , Germany
| | - Andrea Kreisch
- Department of Pediatrics, University Hospital and Medical Faculty Carl-Gustav-Carus, Technische Universität Dresden , Dresden , Germany
| | - Eva Manteufel
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Justus-Liebig University of Giessen , Giessen , Germany
| | - Alexandra Nest
- Department of Pediatric Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich , Munich , Germany
| | - Jenny Prüfe
- Department of Pediatric Hematology and Oncology, Pediatrics III, University Hospital of Essen , Essen , Germany
| | - Lisa Schubert
- Department of Pediatric Hematology and Oncology, University Hospital Würzburg , Würzburg , Germany
| | - Joy Siebrands
- Department of Neuropediatrics, University Hospital of the Goethe-University Frankfurt/M , Frankfurt/M , Germany
| | - Walther Stamm
- Department of Pediatrics and Children's Cancer Research Center, TUM School of Medicine, Technical University of Munich, Kinderklinik München Schwabing , Munich , Germany
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), Germany, German Cancer Consortium (DKTK) , Essen , Germany
| | - Joachim Gerss
- Institute of Biostatistics and Clinical Research, University of Münster , Münster , Germany
| | - Astrid K Gnekow
- Swabian Children’s Cancer Research Center, Pediatric and Adolescent Medicine, Medical Faculty, University of Augsburg , Augsburg , Germany
| | - Michael C Frühwald
- Swabian Children’s Cancer Research Center, Pediatric and Adolescent Medicine, Medical Faculty, University of Augsburg , Augsburg , Germany
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Prüfe J, Pape L, Kreuzer M. Barriers to the Successful Health Care Transition of Patients with Kidney Disease: A Mixed-Methods Study on the Perspectives of Adult Nephrologists. Children 2022; 9:children9060803. [PMID: 35740740 PMCID: PMC9221888 DOI: 10.3390/children9060803] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022]
Abstract
The transition from paediatric to adult-based health care is a challenging period bearing a high risk of medication nonadherence and transplant loss in adolescents and young adults after kidney transplantation. Successful transition asks for the cooperation of many, not least the adult physicians. Yet little is known about their thoughts and attitudes on the transition. We conducted a cross-sectional mixed-methods study, inviting all nephrologists registered with the German Society of Nephrology. A total of 119/1984 nephrologists answered an online survey, and 9 nephrologists participated in expert interviews on transition experiences and perceived barriers. Interviews were thematically analysed. Based on the results, 30 key statements were listed and returned to participants for a ranking of their relevance. The main themes extracted are (1) available resources, (2) patient-related factors, (3) qualification and (4) preparation of and cooperation with the paediatric setting. In conclusion, it became evident that successful transition faces multiple obstacles. At the least, it asks for time, staff, and money. Rigid structures in health care leave little room for addressing the specific needs of this small group of patients. Transition becomes a topic one wants to and is able to afford.
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Affiliation(s)
- Jenny Prüfe
- Department of Pediatrics II, University Children’s Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany; (L.P.); (M.K.)
- Psychosocial Service, University Children’s Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
- Correspondence:
| | - Lars Pape
- Department of Pediatrics II, University Children’s Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany; (L.P.); (M.K.)
| | - Martin Kreuzer
- Department of Pediatrics II, University Children’s Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany; (L.P.); (M.K.)
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Feddersen N, Pape L, Beneke J, Brand K, Prüfe J. Adherence in pediatric renal recipients and its effect on graft outcome, a single-center, retrospective study. Pediatr Transplant 2021; 25:e13922. [PMID: 33227161 DOI: 10.1111/petr.13922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/11/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In recent years, treatment-adherence gained increasing attention in nearly every area of medicine including transplant medicine. Medication adherence following solid organ transplantation is known to be indispensable for a satisfactory allograft survival. METHODS We examined 60 patients between the ages of four months and 20 years who underwent kidney transplantation at Hannover Medical School between January 2011 and August 2017. Age at transplantation varied from 4 months to 20 years. 12 patients (20%) already underwent their second solid organ transplantation. 5 patients (8.3%) had a combined kidney-liver-transplantation. We used two different methods for rating adherence: An objective one based on the coefficient of variation (CoV%) of immunosuppressant trough levels, and a subjective questionnaire answered by the patients themselves, their parents or legal custodians, the treating pediatrician, as well as by the attending psychologist. RESULTS The CoV% in our study was by-trend higher in those patients who suffered from a biopsy-proven rejection (x̅CoV% = 35.7, σ CoV% = 30.1 in patients with rejection vs. x̅ CoV% = 26.0, σ CoV% = 10.5 in patients without rejection). Furthermore, the psychologist's assessment correlated significantly both with rejections as well as with the formation of de novo donor-specific antibodies (dnDSA) while the pediatrician's rating showed no correlation (Prejections = 0.005 and PdnDSA = 0.03 for psychologist's rating vs. Prejections = 0.50 and PdnDSA = 0.50 for pediatrician). CONCLUSIONS Apart from underlining the importance of medication adherence, the present research stresses the role of a multi-disciplinary treatment approach to support pediatric renal transplant recipients and their families.
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Affiliation(s)
- Nele Feddersen
- Clinic for Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Lars Pape
- Clinic for Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.,Clinic for Paediatrics III, Essen University Hospital, Essen, Germany
| | - Jan Beneke
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Hannover Medical School, Hannover, Germany
| | - Korbinian Brand
- Institute for Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | - Jenny Prüfe
- Clinic for Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.,Clinic for Paediatrics III, Essen University Hospital, Essen, Germany
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Prüfe J, Dierks ML, Bethe D, Oldhafer M, Müther S, Thumfart J, Feldkötter M, Büscher A, Sauerstein K, Hansen M, Pohl M, Drube J, Thiel F, Rieger S, John U, Taylan C, Dittrich K, Hollenbach S, Klaus G, Fehrenbach H, Kranz B, Montoya C, Lange-Sperandio B, Ruckenbrod B, Billing H, Staude H, Brunkhorst R, Rusai K, Pape L, Kreuzer M. Transition structures and timing of transfer from paediatric to adult-based care after kidney transplantation in Germany: a qualitative study. BMJ Open 2017; 7:e015593. [PMID: 28606904 PMCID: PMC5734418 DOI: 10.1136/bmjopen-2016-015593] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES It is known that transition, as a shift of care, marks a vulnerable phase in the adolescents' lives with an increased risk for non-adherence and allograft failure. Still, the transition process of adolescents and young adults living with a kidney transplant in Germany is not well defined. The present research aims to assess transition-relevant structures for this group of young people. Special attention is paid to the timing of the process. SETTING In an observational study, we visited 21 departments of paediatric nephrology in Germany. Participants were doctors (n=19), nurses (n=14) and psychosocial staff (n=16) who were responsible for transition in the relevant centres. Structural elements were surveyed using a short questionnaire. The experiential viewpoint was collected by interviews which were transcribedverbatim before thematic analysis was performed. RESULTS This study highlights that professionals working within paediatric nephrology in Germany are well aware of the importance of successful transition. Key elements of transitional care are well understood and mutually agreed on. Nonetheless, implementation within daily routine seems challenging, and the absence of written, structured procedures may hamper successful transition. CONCLUSIONS While professionals aim for an individual timing of transfer based on medical, social, emotional and structural aspects, rigid regulations on transfer age as given by the relevant health authorities add on to the challenge. TRIAL REGISTRATION NUMBER ISRCTN Registry no 22988897; results (phase I) and pre-results (phase II).
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Affiliation(s)
- Jenny Prüfe
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Marie-Luise Dierks
- Department of Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Hannover, Germany
| | - Dirk Bethe
- Division of Paediatric Nephrology, Centre for Child and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Silvia Müther
- Berliner TransitionsProgramm (BTP), DRK-Kliniken (German Red Cross Hospitals) Berlin Westend, Berlin, Germany
| | - Julia Thumfart
- Department of Paediatric Nephrology, Charité, Berlin, Germany
| | | | - Anja Büscher
- Department of Paediatrics II, Essen University Hospital, Essen, Germany
| | | | - Matthias Hansen
- KfH Centre of Paediatric Nephrology, Clementine Children’s Hospital, Frankfurt, Germany
| | - Martin Pohl
- Department of General Paediatrics, Adolescent Medicine and Neonatology, Freiburg University Hospital, Freiburg, Germany
| | - Jens Drube
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Florian Thiel
- University Children’s Hospital Eppendorf, Hamburg, Germany
| | - Susanne Rieger
- Division of Paediatric Nephrology, Centre for Child and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Ulrike John
- University Children’s Hospital, Jena, Germany
| | - Christina Taylan
- Department of Paediatric Nephrology, University Hospital of Cologne, Cologne, Germany
| | | | - Sabine Hollenbach
- KfH Centres of Paediatric Nephrology, St. Georg Hospital, Leipzig, Germany
| | - Günter Klaus
- KfH Centres of Paediatric Nephrology, University Hospital of Marburg, Marburg, Germany
| | - Henry Fehrenbach
- KfH Centre of Paediatric Nephrology, Children’s Hospital Memmingen, Memmingen, Germany
| | - Birgitta Kranz
- University Children’s Hospital Münster, Münster, Germany
| | - Carmen Montoya
- KfH Centre of Paediatric Nephrology, University Children’s Hospital, München, Germany
| | | | - Bettina Ruckenbrod
- Children’s Hospital, Olgahospital Klinikum Stuttgart, Stuttgart, Germany
| | - Heiko Billing
- University Children’s Hospital Tübingen, Tübingen, Germany
| | - Hagen Staude
- University Children’s Hospital, Rostock, Germany
| | - Reinhard Brunkhorst
- KfH Centre of Nephrology, Hospitals of the Hannover Region, Hannover, Germany
| | | | - Lars Pape
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Martin Kreuzer
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
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Kreuzer M, Prüfe J, Oldhafer M, Bethe D, Dierks ML, Müther S, Thumfart J, Hoppe B, Büscher A, Rascher W, Hansen M, Pohl M, Kemper MJ, Drube J, Rieger S, John U, Taylan C, Dittrich K, Hollenbach S, Klaus G, Fehrenbach H, Kranz B, Montoya C, Lange-Sperandio B, Ruckenbrodt B, Billing H, Staude H, Heindl-Rusai K, Brunkhorst R, Pape L. Transitional Care and Adherence of Adolescents and Young Adults After Kidney Transplantation in Germany and Austria: A Binational Observatory Census Within the TRANSNephro Trial. Medicine (Baltimore) 2015; 94:e2196. [PMID: 26632907 PMCID: PMC4674210 DOI: 10.1097/md.0000000000002196] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Transition from child to adult-oriented care is widely regarded a challenging period for young people with kidney transplants and is associated with a high risk of graft failure. We analyzed the existing transition structures in Germany and Austria using a questionnaire and retrospective data of 119 patients transferred in 2011 to 2012. Most centers (73%) confirmed agreements on the transition procedure. Patients' age at transfer was subject to regulation in 73% (18 years). Median age at transition was 18.3 years (16.5-36.7). Median serum creatinine increased from 123 to 132 μmol/L over the 12 month observation period before transfer (P = 0.002). A total of 25/119 patients showed increased creatinine ≥ 20% just before transfer. Biopsy proven rejection was found in 10/119 patients. Three patients lost their graft due to chronic graft nephropathy.Mean coefficient of variation (CoV%) of immunosuppression levels was 0.20 ± 0.1. Increased creatinine levels ≥ 20% just before transfer were less frequently seen in patients with CoV < 0.20 (P = 0.007). The majority of pediatric nephrology centers have internal agreements on transitional care. More than half of the patients had CoV of immunosuppression trough levels consistent with good adherence. Although, 20% of the patients showed increase in serum creatinine close to transfer.
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Affiliation(s)
- Martin Kreuzer
- From the Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School (MK, JP, JD, LP); German Society of Transition Medicine, Hannover (MK, MO, SM, LP); Division of Pediatric Nephrology, Center for Child and Adolescent Medicine, Heidelberg University Hospital, Heidelberg (DB, SR); Department of Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Hannover (M-LD); Berliner Transitions Programm (BTP), DRK-Kliniken (German Red Cross hospitals) Berlin Westend (SM); Department of Pediatric Nephrology, Charité, Berlin (JT); University Hospital of Bonn, Bonn (BH); Department of Pediatrics II, Essen University Hospital, Essen (AB); Childrens' Hospital, University of Erlangen, Erlangen (WR); KfH Center of Pediatric Nephrology, Clementine Childrens' Hospital, Frankfurt (MH); Department of General Pediatrics, Adolescent Medicine and Neonatology, Freiburg University Hospital, Freiburg (MP); University Childrens' Hospital Eppendorf, Hamburg (MJK); University Childrens' Hospital, Jena (UJ); Pediatric Nephrology, University Hospital of Cologne, Cologne (CT); University Childrens' Hospital (KD); KfH Center of Pediatric Nephrology, St. Georg Hospital, Leipzig (SH); KfH Center of Pediatric Nephrology, University Hospital of Marburg, Marburg (GK); KfH Center of Pediatric Nephrology, Childrens' Hospital Memmingen, Memmingen (HF); University Childrens' Hospital Münster (BK); KfH Center of Pediatric Nephrology, University Childrens' Hospital München Schwabing (CM); Dr. von Haunersches Kinderspital, Ludwigs Maximilian University, Munich (BL-S); Childrens' Hospital, Olgahospital Klinikum Stuttgart, Stuttgart (BR); University Childrens' Hospital Tübingen, Tübingen (HB); University Childrens' Hospital, Rostock, Germany (HS); University Childrens' Hospital, Vienna, Austria (KH-R); and KfH Center of Nephrology, Hospitals of the Hannover Region, Hannover, Germany (RB)
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Kreuzer M, Gähler D, Rakenius AC, Prüfe J, Jack T, Pfister ED, Pape L. Dialysis-dependent acute kidney injury in children with end-stage liver disease: prevalence, dialysis modalities and outcome. Pediatr Nephrol 2015; 30:2199-206. [PMID: 26227629 DOI: 10.1007/s00467-015-3156-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 06/16/2015] [Accepted: 06/22/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is a major complication in children with hepatic failure which leads to increased morbidity and mortality. The aim of this study was to provide paediatric data on the prevalence of dialysis-dependent AKI (dAKI), the feasibility and efficacy of dialysis methods and outcome. METHODS We conducted a retrospective analysis of 367 children listed for orthotopic liver transplantation (OLT) in our centre during the past decade. RESULTS Data on 30 children (15 boys, 15 girls) were compiled for retrospective analysis, and data on dialysis feasibility and efficacy were available for 26 of these. Median age was 3.5 (range 0.4-17.7) years. Median MELD (Model For End-Stage Liver Disease) score was 33. dAKI was caused by hepato-renal syndrome in 16 of the 30 children. Twenty-one patients were treated with continuous veno-venous haemofiltration (CVVH), and nine patients received peritoneal dialysis (PD). Overall mortality was 77%. Mortality within the PD-group was 100 % versus 67% in the CVVH-group (p = 0.039). Urea reduction rate within the first 24 h of treatment was 12.9% in the PD group and 23.5% in the CVVH group (p = 0.019). CONCLUSIONS Children with end-stage liver disease have a high risk for dAKI associated with high mortality. CVVH is associated with better efficacy and less mortality than PD.
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Affiliation(s)
- Martin Kreuzer
- Department of Paediatric Nephrology, Hepatology and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
| | - Dagmar Gähler
- Department of Paediatric Nephrology, Hepatology and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Annette C Rakenius
- Department of Paediatric Nephrology, Hepatology and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Jenny Prüfe
- Department of Paediatric Nephrology, Hepatology and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Thomas Jack
- Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Eva-Doreen Pfister
- Department of Paediatric Nephrology, Hepatology and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Lars Pape
- Department of Paediatric Nephrology, Hepatology and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
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Kreuzer M, Prüfe J, Bethe D, Vogel C, Großhennig A, Koch A, Oldhafer M, Dierks ML, Albrecht UV, Müther S, Brunkhorst R, Pape L. The TRANSNephro-study examining a new transition model for post-kidney transplant adolescents and an analysis of the present health care: study protocol for a randomized controlled trial. Trials 2014; 15:505. [PMID: 25539976 PMCID: PMC4355461 DOI: 10.1186/1745-6215-15-505] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 12/10/2014] [Indexed: 11/13/2022] Open
Abstract
Background The transition from pediatric to nephrology care is not yet a standardized procedure. The result is an increased risk of deteriorating transplant function, with the potential for premature transplant failure. Methods/Design In phase I of this study, we shall evaluate the current patient transition situation in all existing German pediatric and nephrology departments (n = 17), including an evaluation of the views of physicians, nurses, and psychosocial support staff regarding transition. Phase II will be a prospective, randomized study in which we compare current unstructured transition (control group) to structured transition (intervention group). The structured transition approach integrates the core elements of the Berliner TransitionsProgramm in combination with two facilitating smartphone apps. The primary endpoint of this study will be therapy adherence, as reflected by group variation coefficients of immunosuppressive agent levels. As a secondary outcome, we will compare patients’ self-reported quality of life, satisfaction of patients and their parents with each transition model, and how patient-centered healthcare components are utilized. These secondary parameters will be assessed with established instruments or with instruments developed (and pilot tested) in phase I of the project. Discussion The long-term goal of this work is to provide a model of structured transition from pediatric to adult care for adolescent nephrology patients, in order to improve transplant survival and patient wellbeing. Trial registration Identifier: Clinicaltrials.gov: ISRCTN22988897, registered on 24 April 2014).
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