Enabling successful transition-Evaluation of a transition to adult care program for pediatric liver transplant recipients.

BACKGROUND: This study aimed to evaluate the transition to adult care program instituted for liver transplant recipients (LTRs) at a large tertiary pediatric hospital in Melbourne, Australia. Evaluation included the change in a Global Assessment Measure (GAM) before and after the transition program, satisfaction with the program, and measures of transition success including rejection rates and attendance at appointments post-transfer. We hypothesized that the introduction of our structured transition program would improve disease understanding, health system understanding, and self-care. We also hypothesized that those who had undergone the transition program would have lower failure to attend rates and lower rates of rejection than historical controls. METHODS: A LTR transition program was instituted at our service from 2013 to 2015. The program involved initial assessment of competencies with a Global Assessment Measure (GAM), followed by the introduction of a personalized goal setting program addressing issues identified in dedicated transition clinics. Assessment of competencies was compared between the commencement of the program and immediately prior to transfer. Patient satisfaction with the transition process was assessed at an interview 6-12 months after transfer to the adult service. Rejection rates and failure to attend rates were compared between the intervention group and a group of LTRs who did not receive the intervention. RESULTS: Twenty-eight LTRs participated in the study; 20 received the transition intervention and 8 served as controls. Within the intervention group, all domains of transition competency and reported anxiety regarding transferring had significantly improved at the conclusion of the intervention and all reported satisfaction with the transition program with most (81%) reporting readiness to transfer. There were no significant differences in rejection rates or failure to attend rates between those who did and did not receive the transition intervention. CONCLUSION: A longitudinal holistic transition program has the potential to positively impact the competencies and readiness of LTRs to successful transition and transfer to adult care.

Effects of increasing standardized ileal digestible lysine during gestation on reproductive performance of gilts and sows.

Limited information is available on lysine requirement estimates of modern, high-producing gestating sows Therefore, the objective of this study was to evaluate the effects of increasing standardized ileal digestible (SID) lysine during gestation on piglet birthweight and reproductive performance of gilts and sows. A total of 936 females (498 gilts, 438 sows; Camborough®, PIC, Hendersonville, TN) were group-housed (approximately 275 females per pen) and individually fed with electronic sow feeders. Females were moved from the breeding stall to pens on d 4 of gestation and allotted to one of four dietary treatments on d 5. Dietary treatments included increasing SID lysine intake (11.0, 13.5, 16.0, and 18.5 g/d). Gilts (parity 1) and sows (parity 2+) received 2.1 and 2.3 kg (22.2 and 24.3 MJ net energy per day) of feed throughout the entire gestation period, respectively. Dietary treatments were achieved by different blends of low (0.48% SID lysine) and high (0.88% SID lysine) lysine diets, prepared by changing the amount of corn and soybean meal in these two diets. Female weight and backfat were recorded on d 4 and 111 of gestation. Individual piglet weight was obtained within 12 h of birth on litters from 895 females. Final weight, and calculated maternal BW, body lipid, and body lean at d 111 of gestation increased (linear, P < 0.01) for gilts and sows as SID lysine increased. There was no evidence for differences in final backfat depth. Average total born for gilts and sows was 15.3 and 16.0 pigs with no evidence for differences among treatments. The percentage of pigs born alive increased (P = 0.01) with increasing SID lysine intake for sows, but not in gilts as a result of a treatment by parity group interaction (P = 0.04) for percentage of stillborn pigs. Increasing SID lysine intake during gestation did not affect the percentage of mummified fetuses, total born, or birthweight of piglets born alive in this study. In addition, increasing SID lysine intake during gestation did not affect subsequent reproductive performance. In conclusion, increasing dietary SID lysine intake in gestation increased female BW, without changing backfat depth. The minimal effects on female reproductive performance and piglet birthweight suggest that 11 g/day of SID lysine intake appears to be adequate for gestating gilts and sows; however, providing sows with 18.5 g/d SID lysine reduced (P = 0.01) stillbirth rate by 2.3 percentage points.

Antithrombotic management and thrombosis rates in children post-liver transplantation: A case series and literature review.

Thrombosis is a major postoperative complication in pediatric liver transplantation. There is marked heterogeneity in prophylactic antithrombotic therapies used, without established guidelines. This review summarizes current worldwide incidence of thrombotic events and compares antithrombotic therapies in children post-liver transplant, with comparison to our institution's experience. Of the twenty-three articles with sufficient detail to compare antithrombotic regimens, the overall incidence of thrombosis ranged from 2.4% to 17.3%. Incidence of HAT ranged from 0% to 28.1%, of HVT from 0% to 4.7%, of PVT from 1.5% to 11.2%, and of IVC thrombosis from 0% to 2.8%. Re-transplantation due to thrombosis ranged from 0% to 4.8%. Prophylactic antithrombotic therapies varied between studies, and bleeding complications were infrequently reported. Since 2010, 96 children underwent 100 liver transplants at our institution with thrombosis incidence comparable to international literature (HAT 6%, PVT 5%, IVC 1%, and HVT 0%). Re-transplantation due to thrombosis occurred in 2% and major bleeding occurred in 10%. The prophylactic antithrombotic therapies used post-liver transplantation in children remain varied. Low rates of thrombosis have been reported with antiplatelet use both with and without anticoagulation. Standard definitions and consistent reporting of bleeding complications are required, in addition to thrombosis rates, so that true risk-benefit assessment of reported regimes can be understood.