Purpose of Review
Many pediatric liver transplant patients are surviving to adulthood, and providers have come to recognize the importance of effectively transitioning these patients to an adult hepatologist. The review aims to analyze the most recent literature regarding patient outcomes after transition, barriers to successful transition, recommendations from clinicians and medical societies regarding transition programs, and to provide personal insights from our experience in transitioning liver transplant recipients.
While results were variable between studies, many recent reports show significant morbidity and mortality in patients following transition to adult care. Medical non-adherence is frequently seen in adolescents and young adults both prior to and after transition, and is consistently associated with higher rates of rejection, graft loss, and death. In general, transplant programs with a formal transition process had better patient outcomes though recent findings are mostly-single center and direct comparison between programs is difficult. Societal recommendations for how to create a transition program contain a number of common themes that we have categorized for easier understanding.
Successful transition is vital to the continued health of pediatric liver transplant patients. While an effective transition program includes a number of key components, it should be individualized to best function within a given transplant center. Here, we have reviewed a number of recent single-center retrospective studies on transition, but multi-site retrospective or prospective data is lacking, and is a fertile area for future research.
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James P. Stevens, Lori Hall, and Nitika A. Gupta declare that they have no conflict of interest.
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Stevens, J.P., Hall, L. & Gupta, N.A. TRANSITION of Pediatric Liver Transplant Patients to Adult Care: a Review. Curr Gastroenterol Rep 23, 3 (2021). https://doi.org/10.1007/s11894-020-00802-1
- Pediatric liver transplantation
- Transition of care
- Pediatric transition
- Adolescent transplantation
- Liver transplant outcomes
- Medication adherence