title: Pediatric Liver Transplant Recipients Who Undergo Transfer to the Adult Healthcare Service Have Good Long-Term Outcomes.
abstract: Liver transplantation has transformed survival for children with liver disease necessitating the transfer of a growing number of patients to the adult healthcare service. The impact of transfer on outcomes remains unclear. The aim of this single-center study of 137 consecutive pediatric liver transplant recipients was to examine the effect of transfer on patient and graft survival. The median time from transplant to transfer was 10.4 years and the median age of the patients at transfer was 18.6 years. After transfer, there were 5 re-transplants and 12 deaths in 14 patients. The estimated posttransfer 10-year patient and graft survival was 89.9% and 86.2%, respectively. Overall, 4 patients demonstrated graft loss as a consequence of chronic rejection. Graft loss was associated with older age at first transplant (p = 0.008). When compared to young adult patients transplanted in the adult center, the transferred patients did not have inferior graft survival from the point of transfer (HR 0.28; 95% CI 0.10-0.77, p = 0.014). This suggests that transfer did not impact significantly on graft longevity. In conclusion, pediatric liver transplant recipients who undergo transfer to the adult service have good long-term outcomes.
authors.affiliation: Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: N
authors.initials: N
authors.lastname: Sagar
authors.affiliation: Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.|NIHR Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Leithead
authors.affiliation: Liver Unit, Birmingham Children's Hospital, Birmingham, UK.
authors.forename: C
authors.initials: C
authors.lastname: Lloyd
authors.affiliation: Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.|Liver Unit, Birmingham Children's Hospital, Birmingham, UK.
authors.forename: M
authors.initials: M
authors.lastname: Smith
authors.affiliation: Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.|NIHR Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK.
authors.forename: B K
authors.initials: BK
authors.lastname: Gunson
authors.affiliation: Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.|NIHR Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK.
authors.forename: D H
authors.initials: DH
authors.lastname: Adams
authors.affiliation: Liver Unit, Birmingham Children's Hospital, Birmingham, UK.
authors.forename: D
authors.initials: D
authors.lastname: Kelly
authors.affiliation: Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: J W
authors.initials: JW
authors.lastname: Ferguson
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000503:physiopathology*; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D060305:Transition to Adult Care; D066027:Transplant Recipients; D055815:Young Adult
keywords: clinical research/practice; graft survival; liver transplantation/hepatology; patient survival; pediatrics; transitional care