https://pubmed.ncbi.nlm.nih.gov/35767565/ Liver transplant

J Pediatr Gastroenterol Nutr. 2022 Jun 27.
doi: 10.1097/MPG.0000000000003549.Online ahead of print.

Education and Psychosocial Factors Predict Odds of Death After Transfer to Adult Healthcare in Pediatric Liver Transplant Patients

James P Stevens 1 2, Scott Gillespie 1, Lori Hall 2, Julia Tisheh 1, Ryan Ford 3, Nitika A Gupta 1 2

PMID: 35767565

DOI: 10.1097/MPG.0000000000003549

Abstract
Objective: To analyze demographic, psychosocial and clinical factors in pediatric liver transplant recipients for their association with death or loss to follow-up in adulthood. We aimed to better understand known health disparities in transplant outcomes and identify potentially modifiable risk factors prior to transfer.

Methods: Retrospective cohort study of children who underwent liver transplantation at a large tertiary transplant center and were transferred to adult care between 2000-2015.

Results: During the study period 101 qualifying patients were transferred. Ninety-three individuals followed with an adult provider, while eight were lost to follow-up. In total 23/93 patients died after transfer (24.7%). Several childhood factors were associated with adult death: Black race (odds ratio [OR] 6.59, p<0.001); psychiatric illness or substance use (OR 2.81, p=0.04); failure to graduate high school (HS) before transfer (OR 9.59, p<0.001); post-transplant tacrolimus medication level variability index >2.5 (OR 5.36, p=0.04); provider documentation of medication non-adherence (OR 4.72, p=0.02); acute cellular rejection (OR 4.44, p=0.03); presence of diabetes mellitus (OR 5.71, p=0.001) and chronic kidney disease (OR 2.82, p=0.04). Failure to graduate HS was associated with loss to follow-up (p<0.001). On multivariate analysis, Black race, substance use, diabetes, and failure to graduate HS retained association with adult death (each p<0.05).

Conclusions: Complex, intertwined patient characteristics are associated with increased odds of death in pediatric liver transplant recipients transferred to adult care. Early recognition of high-risk patients and intervention for modifiable factors, such as improved HS graduation and substance use prevention, may improve long-term outcomes.