title: Ten years of specialized adult care for phenylketonuria - a single-centre experience.
abstract: BACKGROUND
  Specialized adult care of phenylketonuria (PKU) patients is of increasing importance. Adult outpatient clinics for inherited errors of metabolism can help to achieve this task, but experience is limited. Ten years after establishment of a coordinated transition process and specialised adult care for inherited metabolic diseases, adult PKU care was evaluated with respect to metabolic control, therapy satisfaction, life satisfaction, sociodemographic data, economical welfare as well as pregnancy outcome.
  
  
  METHODS
  All PKU patients transferred from paediatric to adult care between 2005 and 2015 were identified. A retrospective data analysis and a cross-sectional survey in a sub-cohort of 30 patients including a questionnaire for assessing quality of life (FLZm) were performed as a single-centre investigation at the metabolic department of the University Hospital Leipzig, Germany. For statistical analysis, Mann-Whitney-U-test, t-test for independent samples, ANOVA and chi square test were used as appropriate.
  
  
  RESULTS
  96 PKU patients (56 females/40 males; median age 32 years, range 18-62) were included. In the last 3-year period, 81% of the transferred patients still kept contact to the adult care centre. Metabolic control was stable over the evaluation period and dried blood phenylalanine concentrations mostly remained within the therapeutic range (median 673.0 μmol/l, range 213.0-1381.1). Sociodemographic data, economical welfare and life satisfaction data were comparable to data from the general population. However, differences could be revealed when splitting the cohort according to time of diagnosis and to management during childhood. 83% of the PKU adults were satisfied with the transition process and current adult care. 25 completed pregnancies were supervised; three newborns, born after unplanned pregnancy, showed characteristic symptoms of maternal PKU syndrome.
  
  
  CONCLUSIONS
  Continuous care for adult PKU patients in a specialized outpatient clinic is successful, leading to good to satisfactory metabolic control and social outcomes. Uninterrupted good metabolic treatment throughout childhood and adolescence positively influences educational, professional and economic success in later life. Further effort in specialized paediatric and adult metabolic care is needed to prevent loss of follow-up and to support the recommended life-long treatment and/or care.
authors.affiliation: Department of Women and Child Health, Hospital for Children and Adolescents, Centre for Paediatric Research Leipzig (CPL), University Hospitals, University of Leipzig, Liebigstr. 20 a, 04103, Leipzig, Germany.|Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospitals, University of Leipzig, Paul-List-Str. 13-15, 04103, Leipzig, Germany.|Division of Neuropediatrics and Inherited Metabolic Diseases, Department of General Pediatrics, University Children's Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Mütze
authors.affiliation: Department of Women and Child Health, Hospital for Children and Adolescents, Centre for Paediatric Research Leipzig (CPL), University Hospitals, University of Leipzig, Liebigstr. 20 a, 04103, Leipzig, Germany. Alena.Thiele@medizin.uni-leipzig.de.
authors.forename: Alena Gerlinde
authors.initials: AG
authors.lastname: Thiele
authors.affiliation: Department of Internal Medicine, University Hospitals, University of Leipzig, Liebigstr.20, 04103, Leipzig, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Baerwald
authors.affiliation: Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospitals, University of Leipzig, Paul-List-Str. 13-15, 04103, Leipzig, Germany.
authors.forename: Uta
authors.initials: U
authors.lastname: Ceglarek
authors.affiliation: Department of Women and Child Health, Hospital for Children and Adolescents, Centre for Paediatric Research Leipzig (CPL), University Hospitals, University of Leipzig, Liebigstr. 20 a, 04103, Leipzig, Germany.
authors.forename: Wieland
authors.initials: W
authors.lastname: Kiess
authors.affiliation: Department of Women and Child Health, Hospital for Children and Adolescents, Centre for Paediatric Research Leipzig (CPL), University Hospitals, University of Leipzig, Liebigstr. 20 a, 04103, Leipzig, Germany.
authors.forename: Skadi
authors.initials: S
authors.lastname: Beblo
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017042:Phenylketonuria, Maternal / Q000097:blood / Q000378:metabolism*; D011247:Pregnancy; D011788:Quality of Life; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Adult care; Maternal PKU syndrome; Metabolic control; Phenylketonuria; Sociodemographic outcome; Transition