随着时间的推移,儿科受者肝移植(LT)后的生存率显着提高。然而,仍然缺乏有关从儿科过渡到成人医疗保健服务(AHS)后结局的数据.因此,我们的目标是前瞻性地评估LT接受者过渡后的结果,获取患者不依从性并确定不依从性的潜在危险因素。
在2010年至2015年期间,对所有连续进入帕多瓦大学医院AHS的青少年LT接受者进行了评估。人口统计数据,肝功能检查,急性或慢性排斥反应发作的发生率和对药物处方的依从性,进行了前瞻性评估。自2015年以来实施了一项教育试点研究,以促进过渡期间的依从性。
总之,评估了32例患者(M/F16/16,中位年龄:23岁)。LT和过渡之间的中位间隔时间为15年(范围:1-26年)。LT的主要指征是胆道闭锁(31%),而免疫抑制方案以他克莫司为基础的占75%。经过29个月的中位随访(范围:12-83),未观察到肝功能试验的显著改变.活检证实的慢性排斥反应在6/32(18%)的患者中被诊断出,他克莫司谷水平的标准差高于无他克莫司谷水平的患者(1.5vs1,P=0.03)。8/32(25%)的患者报告了非依从性,并且与饮酒显着相关(P=.003)。患者和移植物存活率分别为96%和93%,分别。
经历过渡到AHS的青少年LT患者具有良好的长期预后。然而,应使用旨在促进依从性的多学科方法。
Survival rates after liver transplantation (LT) in paediatric recipients have significantly improved over time. However, data regarding outcomes after transition from Paediatric to Adult Healthcare Service (AHS) are still lacking. Therefore, we aimed to prospectively evaluate the outcome of LT recipients after transition, to access patients\' non-adherence and identify potential risk factors for non-adherence.
All consecutive adolescent LT recipients moving to the AHS at Padua University Hospital were evaluated between 2010 and 2015. Demographic data, liver function tests, incidence of acute or chronic rejection episodes and adherence to medical prescription, were prospectively evaluated. An educational pilot study was implemented since 2015 to foster adherence during transition.
In all, 32 patients (M/F 16/16, median age: 23 years) were evaluated. Median interval time between LT and transition was 15 years (range: 1-26 years). The main indication for LT was biliary atresia (31%), whereas immunosuppression regimen was tacrolimus-based in 75%. After a median follow-up of 29 months (range: 12-83), no significant modifications of liver function tests were observed. Biopsy-proven chronic rejection was diagnosed in 6/32 (18%) of patients, who had higher standard deviation of tacrolimus trough level than patients without (1.5 vs 1, P = .03). Non-adherence was reported in 8/32 (25%) of patients and was significantly associated with alcohol consumption (P = .003). Patient and graft survival were 96% and 93%, respectively.
Adolescent LT patients who undergo transition to the AHS have good long-term outcomes. However, a multidisciplinary approach aiming at fostering adherence should be used.