Pediatric Organ Transplantation: Renal & Liver Disease December 4, 2007.
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Transcript of Pediatric Organ Transplantation: Renal & Liver Disease December 4, 2007.
Background Information
Kidney & liver disease are rare in children & adolescents
Medications, dietary changes, & dialysis often are successful treatments
End Stage Renal Disease (ESRD) and End Stage Liver Disease (ESLD)
ESRD
Due to congenital & acquired conditions
Usually requires lifelong dialysis
Hemodialysis
Peritoneal dialysis
ESRD
1/3 – 1/2 of new ESRD patients are potential candidates for transplantation
Less complex & more common than any other organ transplant
Survival rates far exceed 90%
ESLD
May result from infections, structural, metabolic, obstructive, & toxic causes
Chronic hepatitis; biliary atresia, tyrosinemia; ingestion of poisons
¾ of liver cells can be destroyed before it stops functioning
No cure exists for liver failure; transplantation is the only treatment
Liver Transplant Procedures
Technically difficult medical procedure
Healthy organ obtained from a brain-dead patient
Survival rates are lower than for renal transplants, but are improving dramatically
Post-Transplant Medical Management
Post-transplant morbidity
Infection & Rejection
Medication side effects
Repeated blood testing
Potential additional surgeries
Developmental IssuesReduced environmental exposure & exploration for infants & toddlers
Limited social developmentHospitalizations & clinic appointments
Lengthy treatments
Reduced physical stamina
Restricted social system
Developmental Issues
Fears & understanding of medical procedures
Parent-adolescent relations
Dependence
Overprotective parents (e.g., compliance)
Privacy
Perceived lack of control
Neurocognitive Effects of ESRD
Children < 5 yearsSignificant cognitive delays
Children > 5 yearsNo difference in overall IQSpecific differences
Patients w/ earlier onset & longer duration of renal failure performed at lower levels than healthy peers
Psychosocial Effects of ESRD
Dialysis pts more severe difficulties
Fatigue, school absenteeism, health concerns, and physical side effects adjustment difficulties
Short stature
Cushingoid facial features
Neurocognitive Effects of ESLD
Physical effectsHemorrhagingProgressive encephalopathyGrowth failure
Delays in cognitive developmentRelated to duration & severity of liver diseaseChildren dx’d < 1 y.o. at greater risk for global cognitive deficits
Psychosocial Effects of ESLD
Engage in fewer age-appropriate activitiesExperience peer teasing due to physical symptomsFear of death
No external life-sustaining proceduresDifficulty in locating liver25% of pts. qualified for transplant die before the donor is located
Pre-Transplant Evaluation
Intellectual & developmental functioning
Academic achievement
Memory & learning
Pre-Transplant Evaluation
Attention
Visual-motor integration
Personality & psychological functioning
Medication Issues
Steroids (e.g., prednisone)Benefits
Side-effects
Immunosuppressants (e.g., cyclosporine)
Benefits
Side-effects
Other medications
Post-Transplant Compliance
AdolescentsNeg. correlation for symptomatology & compliance
Pos. correlation for body dissatisfaction & noncompliance
Vicious cycle
Interventions aimed at increasing parental involvement & supervision are effective