Adherence, Medical Outcomes, and Health Care Costs in Adolescents/Young Adults Following Pediatric Liver Transplantation

Abstract

Objective: Improved outcomes after pediatric liver transplantation (LT) have led to increasing numbers of adolescent and young adult recipients entering into adult health care systems. The aim of this study was to evaluate the impact of transition from pediatric to adult health care models on medical outcomes, measures of adherence, and health care utilization for pediatric LT recipients. Methods: We evaluated the course of patients who received an LT while followed in pediatrics and transferred to an adult care provider within our institution. Data were collected from 2 years preceding and 2 years following transfer of care. Results: A total of 32 patients were eligible for analysis. Median age at time of transfer was 22.9 years (interquartile range 21.7–23.6). Nine patients (28%) died following transfer of care. There was a significant decrease in office visit adherence following transfer of care (P = 0.02). Although not achieving significance, an increase in alanine aminotransferase values, episodes of acute cellular rejection, progression to cirrhosis, evolution to chronic rejection, and hospital admission rates post transfer were found. These findings were associated with an increase in health care costs related to required interventions. Conclusions: Our study demonstrates trends toward worse health outcomes, decreased adherence, and increased health care utilization following transfer of care. These findings and poor patient survival suggest that the time around transition from pediatric to adult health care models represents a period of increased vulnerability for pediatric LT recipients. Larger, multicenter, prospective studies are needed to identify factors and interventions that affect adolescent and young adult to improve the transition process.

Not everything that counts can be counted: Tracking long-term outcomes in pediatric liver transplant recipients

“…6 Recent singlecenter studies of pediatric LT recipients also reported alarmingly high death rates after transition, 28% of 32 young adults in New York, and 28% of 64 in Atlanta. 7,8 In the latter group, 55% of deaths occurred within 5 years after transition of care. 8 Although our data confirm that young adulthood is a vulnerable time across transplant centers, the OPTN registry unfortunately does not include data on transition of care from the pediatric to an adult center, so we were not able to specifically evaluate the impact of this transition on lost to follow-up, graft dysfunction, or graft loss.…”

Recurrence of Primary Sclerosing Cholangitis After Liver Transplant in Children: An International Observational Study

“…Adherence to prescribed medications may represent one of the few modifiable risk factors to prevent graft loss in these patients. Autoimmune liver disorders have been reported among the highest causes of graft loss and mortality in young adults during the transition of care, ( 36 ) and most children with end‐stage liver disease from PSC are teenagers who transition care to adult programs soon after LT. Unfortunately, out of the scope of this retrospective study is the impact of patient nonadherence to immunosuppression on rPSC and graft dysfunction, but it is a formidable topic for future study.…”

A Bibliometric Analysis of the Landscape of Pediatric Liver Transplantation

“…However, the success in PLT is also accompanied by additional challenges. For example, because of the long-term patient survival and the development of test methods, more long-term problems have been discovered, such as the increased prevalence of medication non-adherence ( 2 ) and hepatitis-related fibrosis ( 3 ). Due to its effectiveness in treating various liver diseases, more conditions are requiring PLT, such as α1-Antitrypsin deficiency ( 4 ) and non-alcoholic fatty liver disease ( 5 ).…”