Langzeitbetreuung lebertransplantierter Kinder und Jugendlicher

I. Goldschmidt; J. Bockhorst; G. Flemming; N. Junge; C. Leiskau; F. Mutschler; E.-D. Pfister; U. Baumann

doi:10.1055/s-0037-1616303

Kinder- und Jugendmedizin, Table of Contents

Kinder- und Jugendmedizin 2016; 16(01): 50-55
DOI: 10.1055/s-0037-1616303

Gastroenterologie

Schattauer GmbH

Langzeitbetreuung lebertransplantierter Kinder und Jugendlicher

Hannoveraner Empfehlungen für die PraxisLong-term follow up for children and adolescents after liver transplantation — aspects of care for the primary care paediatrician

Authors

I. Goldschmidt

¹Pädiatrische Gastroenterologie, Hepatologie und Lebertransplantation, Medizinische Hochschule Hannover
J. Bockhorst

¹Pädiatrische Gastroenterologie, Hepatologie und Lebertransplantation, Medizinische Hochschule Hannover
G. Flemming

²Universitätsklinik und Poliklinik für Kinder und Jugendliche Leipzig
N. Junge

¹Pädiatrische Gastroenterologie, Hepatologie und Lebertransplantation, Medizinische Hochschule Hannover
C. Leiskau

¹Pädiatrische Gastroenterologie, Hepatologie und Lebertransplantation, Medizinische Hochschule Hannover
F. Mutschler

¹Pädiatrische Gastroenterologie, Hepatologie und Lebertransplantation, Medizinische Hochschule Hannover
E.-D. Pfister

¹Pädiatrische Gastroenterologie, Hepatologie und Lebertransplantation, Medizinische Hochschule Hannover
U. Baumann

¹Pädiatrische Gastroenterologie, Hepatologie und Lebertransplantation, Medizinische Hochschule Hannover

Abstract

Zusammenfassung

Jährlich werden in Deutschland mehr als 100 Kinder und Jugendliche erfolgreich lebertransplantiert. Die Nachsorge dieser Kinder erfolgt meist in Partnerschaft zwischen den heimatnah niedergelassenen Kinder- und Jugendärzten, Kinderkliniken vor Ort und den Transplantationszentren. Neben der allgemeinen kinderärztlichen Versorgung ergeben sich für die niedergelassenen Fachärzte Besonderheiten unter anderem durch häufige Blutentnahmen zur Kontrolle von Leberfunktion, Immunsuppression und virologischem Monitoring. Im Umgang mit Infektionen bei den transplantierten Kindern müssen Besonderheiten bei der Auswahl von Antibiotika und die Möglichkeit einer Cholangitis als Differenzialdiagnose bedacht werden. Hinzu kommen Besonderheiten in der Beratung der Eltern und Patienten bezüglich Impfungen und Infektionsprävention. In der jugendmedizinischen Betreuung gewinnen besondere Aspekte bei der Beratung zu Körperbild, Sexualität, Berufswahl und Umgang mit Noxen an Bedeutung.

Summary

Approximately 100 patients annually undergo liver transplantation in Germany. Post-transplant care is usually organized as “shared care” between the transplantation centres and local primary care paediatricians. In addition to general paediatric care and follow-up, liver transplantation often requires frequent and regular clinical and laboratory monitoring. Intercurrent viral and bacterial infections might need a different approach compared to otherwise healthy children. The choice of antibiotics needs to consider drug interactions with immunosuppressive drugs. Rare and specific complications like cholangitis or viral infections may be observed. Counselling with regards to vaccination and prevention of infection needs to take into account the drug-induced immunosuppression. Care for the growing adolescent should incorporate topics such as body image, sexuality, career choice and professional development and substance (ab)use, some of which can be significantly influenced by the transplant experience and health care necessities.

Schlüsselwörter

Lebertransplantation - Nachsorge - Impfungen - Immunsuppression

Keywords

Liver transplantation - post-transplant care - vaccination - immunosuppression

Full Text

References

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