For a study, researchers sought to examine the relationship between demographic, psychological, and clinical characteristics and mortality or loss to follow-up in pediatric liver transplant recipients. It was the goal to learn more about the causes of the health gaps that are already known to exist in transplant outcomes, and to locate any risk factors that might be altered before the operation. From 2000 to 2015, the lives of children who received liver transplants at a major tertiary transplant facility were studied in a retrospective cohort study and then transitioned to adult treatment.
A total of 101 eligible patients were moved during the research period. About 93 people were tracked down by their adult provider, while eight were lost. Twenty-three of the 93 patients (24.7% of the total) who were transferred later died. Several factors in early life were linked to mortality later in life: 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 before transfer (OR 9.59, P<0.001); posttransplant tacrolimus medication-level variability index greater than 2.5 (OR 5.36, P=0.04); provider documentation of medication nonadherence (OR 4.72, P=0.02); acute cellular rejection (OR 4.44, P=0.03); the presence of diabetes mellitus (OR 5.71, P=0.001), and chronic kidney disease (OR 2.82, P=0.04). A high school dropout rate significantly increased the risk of not being located again (P<0.001). Multivariate analysis confirmed the connection between black race, substance use, diabetes, and high school dropout as independent risk factors for death in adults (all P<0.05).
Recipients of childhood liver transplants who are transitioned to adult treatment have an elevated risk of mortality if they have complex, interconnected patient features. Long-term outcomes may be enhanced by early identification of high-risk patients and intervention for modifiable characteristics, such as increased high school graduation rates and decreased rates of substance abuse.