Outcomes after liver transplantation: keep the end in mind.
Since the advent of transplantation as a life-saving procedure for patients with end-stage liver disease, more than 15,000 children and adolescents have received liver transplants. With the improvements in long-term posttransplant survival offered by advances in medical and surgical therapy, the concept of transplantation outcome has expanded beyond simple patient and graft survival rates. The quality of the life years restored, the long-term complications of transplant immunosuppression, and the overall cost of care have been increasingly recognized as important components of liver transplantation outcome. This review focuses on the efforts of a single pediatric transplant center to examine the incidence of, and risk factors for, common posttransplantation complications, to characterize posttransplantation health-related quality of life, to describe the cost of posttransplant care, and to implement novel programs to improve health care delivery. Together, these projects set the future course for research and care improvement initiatives in this population and encourage us to "keep the end in mind" when considering pediatric liver transplantation.
Bucuvalas
John C
JC
Division of Gastroenterology, Hepatology and Nutrition, Pediatric Liver Care Center, Cincinnati Children's Hospital Medical Center and the Department of Pediatrics, University of Cincinnati College of Medicine, OH 45229, USA. john.bucuvalas@cchmc.org
Campbell
Kathleen M
KM
Cole
Conrad R
CR
Guthery
Stephen L
SL
D000293:Adolescent; D001656:Biliary Atresia / Q000188:drug therapy / Q000601:surgery; D015519:Bone Density / Q000187:drug effects; D001847:Bone Diseases / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D065095:Calcineurin Inhibitors; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D016572:Cyclosporine / Q000009:adverse effects; D004791:Enzyme Inhibitors / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006084:Graft Rejection / Q000188:drug therapy / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007255:Information Services; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D007902:Length of Stay / Q000191:economics; D017114:Liver Failure, Acute / Q000188:drug therapy / Q000601:surgery; D016031:Liver Transplantation / Q000191:economics; D008297:Male; D009820:Ohio; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D011788:Quality of Life; D012307:Risk Factors; D016559:Tacrolimus / Q000009:adverse effects; D016896:Treatment Outcome
D065095:Calcineurin Inhibitors; D004791:Enzyme Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus