Childhood Abuse, Nonadherence, and Medical Outcome in Pediatric Liver Transplant Recipients

Shemesh, Eyal; Annunziato, Rachel A.; Yehuda, Rachel; Shneider, Benjamin L.; Newcorn, Jeffrey H.; Hutson, Carolyn; Cohen, Judith A.; Briere, John; Gorman, Jack M.; Emre, Sükrü

doi:10.1097/chi.0b013e3180f62aff

Cited by 35 publications

(40 citation statements)

References 29 publications

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“…The compelling reason to implement these assessments as routine practice is that there have been numerous studies19–23 which have demonstrated that psychosocial risks are associated with poor posttransplant medical outcomes. If all published studies about psychosocial risks in solid organ transplant recipients (children and adults) are considered, the risks include a dizzying array of factors, which are summarized elsewhere 24–29.…”

Section: Psychosocial Assessmentmentioning

confidence: 99%

“…Studies that are not hypothesis‐driven (for example, rather than investigating 1 risk factor prospectively, they look at the psychosocial profile of recipients or look at a large number of predictors) suffer from a high likelihood of spurious results. In children who have had a liver transplant, the only psychosocial risk factor that has been shown to be predictive of poor medical outcomes in a prospective, targeted study is a history of child abuse 23. Other candidate predictors in this particular population are posttraumatic stress disorder (PTSD) and depression 30, 31.…”

Section: Psychosocial Assessmentmentioning

confidence: 99%

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Directed differentiation of human embryonic stem cells into functional hepatic cells†

et al. 2007

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The differentiation capacity of human embryonic stem cells (hESCs) holds great promise for therapeutic applications. We report a novel three-stage method to efficiently direct the differentiation of human embryonic stem cells into hepatic cells in serum-free medium. Human ESCs were first differentiated into definitive endoderm cells by 3 days of Activin A treatment. Next, the presence of fibroblast growth factor-4 and bone morphogenetic protein-2 in the culture medium for 5 days induced efficient hepatic differentiation from definitive endoderm cells. Approximately 70% of the cells expressed the hepatic marker albumin. After 10 days of further in vitro maturation, these cells expressed the adult liver cell markers tyrosine aminotransferase, tryptophan oxygenase 2, phosphoenolpyruvate carboxykinase (PEPCK), Cyp7A1, Cyp3A4 and Cyp2B6. Furthermore, these cells exhibited functions associated with mature hepatocytes including albumin secretion, glycogen storage, indocyanine green, and low-density lipoprotein uptake, and inducible cytochrome P450 activity. When transplanted into CCl 4 injured severe combined immunodeficiency mice, these cells integrated into the mouse liver and expressed human alpha-1 antitrypsin for at least 2 months. In addition, we found that the hESC-derived hepatic cells were readily infected by human immunodeficiency virus-hepatitis C virus pseudotype viruses. Conclusion: We have developed an efficient way to direct the differentiation of human embryonic stem cells into cells that exhibit characteristics of mature hepatocytes. Our studies should facilitate searching the molecular mechanisms underlying human liver development, and form the basis for hepatocyte transplantation and drug tests. (HEPATOLOGY 2007;45: 1229-1239.)

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Section: Psychosocial Assessmentmentioning

confidence: 99%

Section: Psychosocial Assessmentmentioning

confidence: 99%

Directed differentiation of human embryonic stem cells into functional hepatic cells†

et al. 2007

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“…Complex traumatic stress may interfere with how well patients and families follow the recommendations of their health care providers, although the literature addressing this potential association is sparse. In one study, children who had been physically or sexually abused had poorer adherence rates following a liver transplant than children who had not experienced abuse (Shemesh et al, 2007). This may have contributed to the increased transplant rejection and mortality rates of abused children (Lurie et al, 2000).…”

Section: The Influence Of Complex Traumatic Stress On Health-related mentioning

confidence: 98%

Complex Traumatic Stress in the Pediatric Medical Setting

Brosbe

Faust

Gold

2013

Journal of Trauma & Dissociation

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There has been a recent increase in research focusing on child complex traumatic stress following prolonged or repeated trauma. These traumatic stress reactions often affect many aspects of the child's functioning, including psychological, behavioral, and physical health. In addition, complex traumatic stress experienced by youth with serious medical conditions may influence health issues such as medical adherence, emotional adjustment to illness, and pain management. This article reviews and delineates the current state of the literature on the impact of complex traumatic stress in childhood on mental and physical health as well as on these pediatric health-related issues. To date, few empirical studies have directly addressed this association. Several features associated with complex traumatic stress, such as emotion regulation difficulties, disruptive behavior, and family conflict, have indirectly been demonstrated to interfere with pediatric adherence, medical coping, and pain management. This demonstrates the need for more focused research in this area.

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“…This includes intensive monitoring of adherence, increasing the frequency of clinic visits (22), changing the prescribed regimen to a simpler or a more palatable one, interactive and detailed education, and evaluating risk factors and barriers to adherence and addressing them. Common risk factors that predispose patients to nonadherence include, but are not limited to, patchy medical insurance coverage or low socioeconomic status, lack of family support including – at the extreme – child abuse (23), psychopathology including depression and posttraumatic stress disorder (20), and cognitive deficits including memory loss due to hepatic failure. In the opinion of the authors of the present manuscript, medication side effects are not common reasons for nonadherence.…”

Section: What To Do When a Patient Is Not Taking The Medications As Pmentioning

confidence: 99%

Adherence to medical recommendations and transition to adult services in pediatric transplant recipients

Shemesh

Annunziato

Arnon

et al. 2010

Current Opinion in Organ Transplantation

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Purpose of review Nonadherence to treatment recommendations, especially when associated with transition to adult care providers, account, by some estimates, for most organ rejections and death in long-term pediatric survivors of solid organ transplantations. It is therefore imperatives that providers become familiar with the issues related to those major risks and ways to address them. Recent findings It is possible, and important, to routinely measure adherence to medications by using one of several available and proven methods of surveillance. There are numerous ways to improve adherence, and it is in fact possible to improve adherence and therefore outcomes in the transplant setting. The transition to adult services is a vulnerable period. The authors believe that it is possible to improve the transition process, and suggestions are presented in this review. However, solid research into interventions to improve transition is sorely lacking. Summary Nonadherence to medical recommendations is prevalent and leads to poor outcomes following otherwise successful pediatric transplantation. An especially vulnerable period is the time when a recipient transitions to adult care. Routine monitoring of adherence, evaluating and addressing barriers to adherence, and collaborative, multidisciplinary care are all expected to substantially improve adherence and reduce the risks associated with transition.

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Childhood Abuse, Nonadherence, and Medical Outcome in Pediatric Liver Transplant Recipients

Cited by 35 publications

References 29 publications

Directed differentiation of human embryonic stem cells into functional hepatic cells†

Directed differentiation of human embryonic stem cells into functional hepatic cells†

Complex Traumatic Stress in the Pediatric Medical Setting

Adherence to medical recommendations and transition to adult services in pediatric transplant recipients

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