Download Pediatric Organ Transplantation: Renal & Liver Disease

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 braindead 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 Issues
Reduced environmental exposure & exploration
for infants & toddlers
Limited social development
Hospitalizations & 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 years
Significant cognitive delays
Children > 5 years
No difference in overall IQ
Specific 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 effects
Hemorrhaging
Progressive encephalopathy
Growth failure
Delays in cognitive development
Related to duration & severity of liver
disease
Children dx’d < 1 y.o. at greater risk for
global cognitive deficits
Psychosocial Effects of ESLD
Engage in fewer age-appropriate
activities
Experience peer teasing due to
physical symptoms
Fear of death
No external life-sustaining procedures
Difficulty in locating liver
25% 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
Pre-Transplant Evaluation
Family functioning
Evaluation of the
donor
Assessment of
compliance
Ethical concerns
Medication Issues
Steroids (e.g., prednisone)
Benefits
Side-effects
Immunosuppressants (e.g.,
cyclosporine)
Benefits
Side-effects
Other medications
Effects of Transplantation
Neurocognitive effects
Psychosocial effects
Post-Transplant Compliance
Adolescents
Neg. correlation for symptomatology &
compliance
Pos. correlation for body dissatisfaction
& noncompliance
Vicious cycle
Interventions aimed at increasing
parental involvement & supervision are
effective