Abstracts

PEDIATRIC LIVER TRANSPLANT RECIPIENTS AT ≥ 20 YEARS: PERCEPTIONS OF COGNITIVE AND PHYSICAL FUNCTIONING IN THE LONG-TERM SURVIVOR.

Beverly Kosmach-Park, Jodi Rosenbleet, Basil Zitelli, George Mazariegos. Dept. of Transplant Surgery, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA; Dept. of Pediatrics, Children’s Hospital of Pittsburgh, Pittsburgh, PA.

Purpose: Of a cohort of 287 pediatric OLTx recipients (1981–86), 146 survivors of this landmark period are now > 20 years post-tx, representing the first group to achieve long-term survival under calcineurin inhibitors. This study assessed recipients' perceptions of long-term physical and cognitive outcomes.

Method: A 135-item questionnaire assessed subjective responses concerning physical and cognitive functioning, medical care, peer/family relationships, educational/employment issues, and wellness. Descriptive statistics and correlations were completed.

Results: 44 patients (30%) participated at 19.83 – 22.92 yrs post-tx. Mean age: 24.11 yrs (range: 18.25–35 yrs). Mean age at OLTx: 4.85 yrs (SD + 4.72; range 0.25–17 yrs). The majority are single (79.5%) and live with parents (47.7%). Recipients report being generally healthy (8.17; range 4.0–10.0) with infrequent illnesses (4.86; range 1.0–9.0), yet worry about infections (6.97; range 1.0–10.0). Reported complications include rejection, HTN, fatigue,↑RFTs, with 1 patient requiring renal tx. The most common infections include varicella (66.7%); CMV (22%), EBV (14.8%), and HCV (14.8%). 70% of patients are prescribed < 2 meds with 8 patients off all immunosuppression (IS). IS includes tacrolimus (55.6%), cyclosporine (38.9%); azathioprine (13.9%), prednisone (30.5%). Significant differences were seen in some areas when comparing patients off IS to those requiring IS. Those off IS reported being in better general physical health (mean 91.00 vs 79.17; p= .044), have a more positive view in being a OLTx recipient, have greater involvement in sports (FET = .036); have less difficulty in obtaining employment due to insurance issues (FET = .039); and believe they have a life similar to peers (trend; FET = .080). The IS group reported employment limitations due to OLTx (trend, FET = .073; p = .07). Recipients living with parents reported that they are less active (p=.001), rely on parents for medical care (p=.011), and feel different from others because of OLTx (trend; p=.080). Over 25% have associate/bachelor's degrees and 59% are employed.

Conclusions: This landmark group perceives themselves as generally healthy and are employed, educated young adults. However, data suggests that patients off IS and those living independently have achieved more favorable outcomes.