Outcomes of adults who received liver transplant as young children

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 transpla...

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Main Authors: Sunitha Vimalesvaran, Lara Neves Souza, Maesha Deheragoda, Marianne Samyn, Jemma Day, Anita Verma, Hector Vilca-Melendez, Mohamed Rela, Nigel Heaton, Anil Dhawan
Format: Article
Language:English
Published: Elsevier 2021-08-01
Series:EClinicalMedicine
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S2589537021002674
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spelling doaj-746e99f3266743a29cb0887c013686a52021-08-28T04:47:57ZengElsevierEClinicalMedicine2589-53702021-08-0138100987Outcomes of adults who received liver transplant as young childrenSunitha Vimalesvaran0Lara Neves Souza1Maesha Deheragoda2Marianne Samyn3Jemma Day4Anita Verma5Hector Vilca-Melendez6Mohamed Rela7Nigel Heaton8Anil Dhawan9Paediatric Liver, GI and Nutrition Center and Mowat Labs, King's College Hospital, Denmark Hill, London SE5 9RS, United KingdomLiver Histopathology Laboratory, Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United KingdomLiver Histopathology Laboratory, Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United KingdomPaediatric Liver, GI and Nutrition Center and Mowat Labs, King's College Hospital, Denmark Hill, London SE5 9RS, United KingdomPaediatric Liver, GI and Nutrition Center and Mowat Labs, King's College Hospital, Denmark Hill, London SE5 9RS, United KingdomPaediatric Liver, GI and Nutrition Center and Mowat Labs, King's College Hospital, Denmark Hill, London SE5 9RS, United KingdomLiver and Intestinal Transplant Surgical Service, King's College Hospital, London, United KingdomInstitute of Liver disease and Transplantation, Dr Rela Institute and Medical Center, Bharat Institute of Higher Education and Research, Chennai, IndiaLiver Histopathology Laboratory, Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United KingdomPaediatric Liver, GI and Nutrition Center and Mowat Labs, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom; Corresponding author.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 0·7–3·3 years), with median duration of follow-up of 20.2 years (18·0–23·5). 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 long-term 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. Funding: None.http://www.sciencedirect.com/science/article/pii/S2589537021002674pediatricLiver transplantationlong-termbiopsychosocialoutcomes
collection DOAJ
language English
format Article
sources DOAJ
author Sunitha Vimalesvaran
Lara Neves Souza
Maesha Deheragoda
Marianne Samyn
Jemma Day
Anita Verma
Hector Vilca-Melendez
Mohamed Rela
Nigel Heaton
Anil Dhawan
spellingShingle Sunitha Vimalesvaran
Lara Neves Souza
Maesha Deheragoda
Marianne Samyn
Jemma Day
Anita Verma
Hector Vilca-Melendez
Mohamed Rela
Nigel Heaton
Anil Dhawan
Outcomes of adults who received liver transplant as young children
EClinicalMedicine
pediatric
Liver transplantation
long-term
biopsychosocial
outcomes
author_facet Sunitha Vimalesvaran
Lara Neves Souza
Maesha Deheragoda
Marianne Samyn
Jemma Day
Anita Verma
Hector Vilca-Melendez
Mohamed Rela
Nigel Heaton
Anil Dhawan
author_sort Sunitha Vimalesvaran
title Outcomes of adults who received liver transplant as young children
title_short Outcomes of adults who received liver transplant as young children
title_full Outcomes of adults who received liver transplant as young children
title_fullStr Outcomes of adults who received liver transplant as young children
title_full_unstemmed Outcomes of adults who received liver transplant as young children
title_sort outcomes of adults who received liver transplant as young children
publisher Elsevier
series EClinicalMedicine
issn 2589-5370
publishDate 2021-08-01
description 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 0·7–3·3 years), with median duration of follow-up of 20.2 years (18·0–23·5). 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 long-term 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. Funding: None.
topic pediatric
Liver transplantation
long-term
biopsychosocial
outcomes
url http://www.sciencedirect.com/science/article/pii/S2589537021002674
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