&lt;p&gt;Improving Patient Outcomes Following Pediatric Liver Transplant: Current Perspectives&lt;/p&gt;

Cuenca, Alex G.; Yeh, Heidi

doi:10.2147/trrm.s183382

Cited by 8 publications

(8 citation statements)

References 48 publications

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“…The patient and graft survival rates in this study are comparable, in part superior, to those previously reported in the literature [9,23,24]. The largest series published so far on pediatric liver transplantation demonstrated 1-year survival rates of 84.4% in the last cohort (2013-2019) [25].…”

Section: Discussionsupporting

confidence: 81%

Over 30 Years of Pediatric Liver Transplantation at the Charité—Universitätsmedizin Berlin

Moosburner

Wiering

Gül‐Klein

et al. 2022

JCM

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Background: Pediatric liver transplantation (LT) is the treatment of choice for children with end-stage liver disease and in certain cases of hepatic malignancies. Due to low case numbers, a technically demanding procedure, the need for highly specialized perioperative intensive care, and immunological, as well as infectious, challenges, the highest level of interdisciplinary cooperation is required. The aim of our study was to analyze short- and long-term outcomes of pediatric LT in our center. Methods: We conducted a retrospective single-center analysis of all liver transplantations in pediatric patients (≤16 years) performed at the Department of Surgery, Charité – Universitätsmedizin Berlin between 1991 and 2021. Three historic cohorts (1991–2004, 2005–2014 and 2015–2021) were defined. Graft- and patient survival, as well as perioperative parameters were analyzed. The study was approved by the institutional ethics board. Results: Over the course of the 30-year study period, 212 pediatric LTs were performed at our center. The median patient age was 2 years (IQR 11 years). Gender was equally distributed (52% female patients). The main indications for liver transplantation were biliary atresia (34%), acute hepatic necrosis (27%) and metabolic diseases (13%). The rate of living donor LT was 25%. The median cold ischemia time for donation after brain death (DBD) LT was 9 h and 33 min (IQR 3 h and 46 min). The overall donor age was 15 years for DBD donors and 32 years for living donors. Overall, respective 1, 5, 10 and 30-year patient and graft survivals were 86%, 82%, 78% and 65%, and 78%, 74%, 69% and 55%. One-year patient survival was 85%, 84% and 93% in the first, second and third cohort, respectively (p = 0.14). The overall re-transplantation rate was 12% (n = 26), with 5 patients (2%) requiring re-transplantation within the first 30 days. Conclusion: The excellent long-term survival over 30 years showcases the effectiveness of liver transplantation in pediatric patients. Despite a decrease in DBD organ donation, patient survival improved, attributed, besides refinements in surgical technique, mainly to improved interdisciplinary collaboration and management of perioperative complications.

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Section: Discussionsupporting

confidence: 81%

Over 30 Years of Pediatric Liver Transplantation at the Charité—Universitätsmedizin Berlin

Moosburner

Wiering

Gül‐Klein

et al. 2022

JCM

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“…Whilst long-term outcomes may vary across different geographical locations, the general themes remain the same [13,14] These long-term issues include graft disease, side effects of immunosuppression, poor growth and metabolic syndrome, and the psychosocial impact of transplantation as they transition to adult care. Few reports have addressed 20-year pLT survivors, and even fewer have focused on the biopsychosocial outcomes of these survivors [13,15,16].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of adults who received liver transplant as young children

et al. 2021

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Background: Patient and graft survival 20-years after pediatric liver transplantation (pLT) are excellent. In children, attainment of normal growth, education and social adaptation to be an independent adult are equally important. This is particularly relevant for children who receive liver transplant at a young age, where infantile-onset liver disease, surgery and immunosuppression can adversely affect growth and neurodevelopment. The aim of this study was to evaluate the long-term physical and psychosocial outcomes of pLT recipients with normal graft function. We coin the term 'meaningful survival'. Methods: We performed a cross-sectional study of pLT recipients who received transplants between 1985 and 2004. A 20-year evaluation of physical health (growth, renal function), mental wellbeing and social outcomes (substance abuse, adherence, education, employment) was performed. All patients included were considered to have normal graft function. Findings: Eighty-four patients met study criteria. Median age at transplantation was 1.3 years (IQR 0¢7À3¢3 years), with median duration of follow-up of 20.2 years (18¢0À23¢5). At median of 20-years, 19 patients (23%) had chronic renal dysfunction and 3 patients (4%) had a BMI of >30 (mean 20¢4). Evaluation of longterm psychosocial outcomes demonstrated 22 patients (26%) with mental health disorders. Substance abuse was lower than national average. 62 patients (74%) were in education, employment or training. Overall, only 26% of our cohort achieved a composite outcome of 'meaningful survival'. Interpretation: This is the largest reported long-term study of biopsychosocial outcomes of pLT recipients with normal liver biochemistry, with follow-up upon completion of physical growth and senior school education. Importantly, despite normal liver function, many patients did not demonstrate 'meaningful survival'. We must refocus our efforts towards better understanding the long-term outcomes of children. A 'meaningful survival' rather than mere survival should be our goal.

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“…KTx is the optimal treatment for end-stage kidney failure due to several causes both in adults and in younger patients [5,6]. It is important to understand that as the survival rate increases, at the same time, it increases the risk of developing further diseases in these patients, often due to the medications used [7]. In particular, LTx can lead to kidney injury, diabetes, infectious diseases, deficits or delays in childhood development.…”

Section: Introductionmentioning

confidence: 99%

Preliminary Evaluation of Sedentary Lifestyle in Italian Children after Solid Transplant: What Role Could Physical Activity Play in Health? It Is Time to Move

Tranchita

Cafiero

Giordano

et al. 2023

IJERPH

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Background: Advances in the medical–surgical field have significantly increased survival after solid organ transplantation in the pediatric population. However, these patients are predisposed to the development of long-term complications (e.g., cardiovascular disease). The therapeutic role of physical activity (PA) to counteract these complications is well known. The purpose of the study was to investigate the level of PA in a pediatric population after solid organ transplantation. Methods: In the first 4 weeks at the beginning of the school year, the Physical Activity Questionnaire for Older Children and Adolescents was administered to young patients who had previously undergone solid transplants at our institute. Results: Questionnaires of 49 patients (57.1% female, mean age 13.2 ± 3.5 years) were analyzed and 32.7% of subjects did not perform any exercise during school physical education classes. Only 24% practiced a moderate quantity of exercise in the previous week (2–3 times/week) and 72% engaged in sedentary behaviors during weekends. Conclusions: Preliminary data confirmed that young recipients are still far from meeting the minimum indications of the World Health Organization on PA and sedentary behavior. It will be necessary to increase their involvement in PA programs in order not only to increase their life expectancy but also to improve their quality of life.

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<p>Improving Patient Outcomes Following Pediatric Liver Transplant: Current Perspectives</p>

Cited by 8 publications

References 48 publications

Over 30 Years of Pediatric Liver Transplantation at the Charité—Universitätsmedizin Berlin

Over 30 Years of Pediatric Liver Transplantation at the Charité—Universitätsmedizin Berlin

Outcomes of adults who received liver transplant as young children

Preliminary Evaluation of Sedentary Lifestyle in Italian Children after Solid Transplant: What Role Could Physical Activity Play in Health? It Is Time to Move

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