Management of adults with paediatric-onset chronic liver disease: Strategic issues for transition care

Short‐term outcomes of paediatric liver transplant recipients after transition to Adult Healthcare Service

“…The most relevant issues raised by the present findings concern the age of recipients at transition, around 23 years, and the fact that all LT recipients underwent transition after reaching 18 years of age. Though still controversial, and varying in different studies, 9,10 cipients whose transition took place at 16-25 years of age were more anxious and depressed than those who switched to adult healthcare services between 12 and 18 years old, confirming the vulnerability of this specific age bracket. In another study, anxiety, loneliness and negative thoughts were reported in 53%, 84% and 47%, respectively, of the young adults interviewed (17-33 years old), and 11% of the sample considered were in the care of psychologists or psychiatrists.…”

“…The most relevant issues raised by the present findings concern the age of recipients at transition, around 23 years, and the fact that all LT recipients underwent transition after reaching 18 years of age. Though still controversial, and varying in different studies, the recommended age for transition to AHS is 18 years, at which point a person is considered an adult in Italy and numerous other European countries. The reasons for a later transition in our sample might relate to the difficulty of achieving a steady psychological, biochemical and clinical condition, and to the fact that paediatricians may continue to care for their patients during the adolescents' “invisible early twenties,” a demographic twilight zone in which they are not fully integrated into adult care services .…”

“…Lastly, the adolescent LT recipient's quality of life (QoL)—in terms of schooling, employment, sexual function and fertility, among others—has elements that differ from the situation in the adult LT population, and that contribute to the former's worse short‐and long‐term outcomes . Transplant hepatologists and paediatricians have switched from the concept of adolescent patients' transfer (a change in the location where care is provided) to one of transition , as an active process that addresses these patients' medical, psychosocial and educational/vocational needs as they prepare to move on from child‐ to adult‐centred healthcare . It remains unclear, however, whether there is a specific “right” time for this transition after LT, and how it affects graft and patient outcomes.…”

“…An Italian position paper stated that the optimal age for the transition of patients with chronic liver diseases is between 16 and 18 years old, but no clear recommendations for adolescent LT recipients have been published as yet. In addition, given the controversial reports on how QoL affects adherence, we need to know more about how best to manage adolescents during this phase of their care. The aims of the present study were, therefore, to examine the outcome of LT recipients after their transition from paediatric to adult healthcare services (AHS); to assess patients' non‐adherence after transition, and identify risk factors for non‐adherence; to identify potential factors during transition associated with non‐adherence by means of a dedicated pilot programme.…”

“…6,7 Transplant hepatologists and paediatricians have switched from the concept of adolescent patients' transfer (a change in the location where care is provided) to one of transition, as an active process that addresses these patients' medical, psychosocial and educational/ vocational needs as they prepare to move on from child-to adultcentred healthcare. [8][9][10] It remains unclear, however, whether there is a specific "right" time for this transition after LT, and how it affects graft and patient outcomes. An Italian position paper 11 stated that the optimal age for the transition of patients with chronic liver diseases is between 16 and 18 years old, but no clear recommendations for adolescent LT recipients have been published as yet.…”