What the impact of Pediatric transplants that help children live longer, more normal lives?
Title: The following report presents a systematic review of the impact of pediatric transplants on the quality of life of children and the prospects for their long lives.
Abstract: The effectiveness of pediatric transplants has been responsible for providing a better chance at life to many children. The background of the following review was based on identification of the specific factors that contributed to the quality and longevity of life for recipients of pediatric transplants. The following research presented a literature review through critical reflection on various academic journals that comprised of references to the impacts of pediatric transplantation.
The results derived from the literature were presented on the grounds of inferential review and the discussion was based on thematic analysis that provided insights into three distinct factors that were responsible for influencing the quality of life of children post-transplantation (Azeka, Saavedra & Fregni, 2014). The use of qualitative studies in the report was helpful for drawing credible outcomes from the thematic analysis. Furthermore, it is essential to focus on the ethical concerns addressed in conducting the research.
Introduction: As per Green et al., (2007), organ transplantation has been the major cause of transforming the lives of many people including children along with adults suffering from organ failure. One of the first examples of pediatric transplantation could be identified in the kidney transplant between identical twins to address the issue of rejection due to MHC incompatibility (Green et al., 2007).
Solid organ transplantation has turned out to be a promising factor for improving patient survival rates as well as sustainability of the allograft survival alongside reducing the detrimental consequences arising from immunosuppression. The primary rationale of the report is vested in identification of the impact of pediatric transplants in extending as well as improving the quality of life for children (Glotzbach, May & Wray, 2018).
The objectives of the report could be highlighted with respect to the PICO framework that represents the participants, interventions, comparisons and outcomes of the study. The participants in the study were accounted to be children in the age group of 6-12 years. The interventions were accounted as the occurrence of transplants in a period larger than but not limited to 6 months before the study. As per Kim & Marks (2014), the comparisons or control factors would be derived from focused ethnographic studies that can be used to compare the different outcomes of the pediatric transplantation interventions (Kim & Marks, 2014). The outcomes of the study would be inclined towards identification of the factors that are responsible for influencing the quality of life after pediatric transplants. The structured report for presenting a literature review would follow the PRISMA framework by highlighting the methods, results, and discussion of the review alongside the ethical implications followed for the research.
Literature review: As per Liberati et al (2009), the instances of patient survival after transplantation have improved over the course of the last decade. One of the examples to validate this statement could be presented in the form of the 5-year survival rate through deceased donor renal transplantation which has increased to 96% in the period ranging from1996-2007 as compared to 91%in the era of 1987-1995 (Liberati et al., 2009).
The improvements have been primarily observed in the peri-operative period and the primary factors which can be considered responsible for the improvements are identified in improved procurement of donors, advanced HLA testing methods, improved techniques for micro-anastomosis and surgical techniques as well as matching schemes. HLA typing has been improved substantially through direct DNA sequencing thereby contributing to the precision in outcomes that is supported by the favourable implications of flow cytometric bead-based technology for detection of HLA antibodies (Parmar, Vandriel & Ng, 2017). Flow cytometry also facilitates favourable implications for predicting the alloimmune responses prior to transplantation that contribute to effective virtual crossmatching. The technology is also liable to provide the functionality of detecting alloantibodies that are formed de novo after transplant.
On the other hand, it is essential to understand that transplantation in the case of infants has to be associated with special emphasis owing to various factors such as incompatibility of donor and recipient size as well as congenital heart disease for cardiac transplants, biliary atresia in case of liver transplants and congenital deficiencies identified in the urinary tract and kidney for renal transplants (Schulte et al., 2016). The cases of transplantation in infants have also been associated with concerns of reduced allograft and patient survival rates. As per Todaro et al (2000), in the case of deceased donor transplants, the overall patient survival rate for children at 3 years was found to be 93% that is comparatively lesser than older children having transplants which are estimated in the range of 96-99% (Todaro et al., 2000). It is also imperative to observe that the survival rate does not depict any substantial differences in the case of living donor transplants. Furthermore, it has been estimated that infants surviving the period immediately post the operation are more likely to show favourable results similar to that of older children. The increased availability of organs has been identified in context of the ABO blood group barrier.
According to the reports from the Paediatric Heart Transplant Study database comprising of 931 cases of ABO-incompatible cardiac transplants for recipients below the age of 15 months, there were limited instances of rejection and minimal differences in mortality rates (Vandekerckhove et al., 2016). One study in a small single-centre on pediatric liver transplants for the weight range less than 5 kg, the survival rates were comparable to ABO-compatible transplants. The prospects of successful survival among infants are found to be influenced by the factors of higher acceptance for ABO mismatches alongside the implications of a less-developed immune system in infants. In the case of older children, the outcomes of the antibody removal through rituximab or plasma exchange are responsible for moderation of blood group antibody levels to reasonable amounts often aimed at a dilution ratio of 1:8 (Yadav et al., 2017).
Implications of growth: The chronic conditions for which the children are subject to paediatric transplants are responsible for limited growth as compared to other children before the transplantation. On the other hand, post effects of transplantation have depicted references to promising growth. Data obtained from NAPRCTS suggest prominent indications towards the higher extent of catch-up growth depicted by children subject to pediatric transplantation prior to the age of six years. Another study has also depicted evaluation of outcomes over the course of 3 years post renal transplantation for children under the age of 5 years that suggest better growth in the corticosteroid-free regimen (Glotzbach, May & Wray, 2018).
The corticosteroid-free regimen was found to be responsible for higher safety, lower blood pressure and inhibition of cholesterol levels. Therefore, these factors implied prominently towards the emphasis on early withdrawal of corticosteroids in cases when complete withdrawal is not possible in transplants without complexities (Parmar, Vandriel & Ng, 2017). The application of recombinant human growth hormone has been subject to various controversies and one of the foremost criticisms is presented in the form of increased probabilities of PTLD.One of recently provided Cochrane update emphasizes on the fact that treatment of infants with growth hormone was responsible for increased velocity of increase in height.
On the other hand, the application of the recombinant human growth hormone has been associated with limitations of costs in resource-deficient countries (Vandekerckhove et al., 2016). However, these limitations could be balanced through improving calorie intake as well as nutrition that lead to promising growth outcomes in recipients. Another significant aspect to be noted in context of the growth of recipients of pediatric transplants is the minimal instances of delay in puberty albeit with the concerns of delay in bone age and accomplishing final height.
Quality of life: Despite the contribution of pediatric transplants in the resolution of chronic conditions, the recipients are found to depict underlying chronic health issues throughout the course of their life. This emphasizes on the requirement of focusing the objectives of transplantation on improving the quality of life as well as longevity (Glotzbach, May & Wray, 2018). Therefore it can be inferred that the introduction of a holistic approach on behalf of the multi-disciplinary team for transplantation as well as the support of psychologists, social workers, and primary care physicians would be mandatory for improving the quality of life following the transplantation.
These factors are responsible for addressing the concerns of attention problems, improving long-term relationships with other children and reducing absenteeism at school as well as improvement in academic performance. Transition to adolescence is also another significant factor to be considered with respect to the quality of life of pediatric transplantation recipients (Vandekerckhove et al., 2016).
The period of adolescence is responsible for the limited compliance with immunosuppression thereby contributing to the loss of the functioning graft. This requires the prominent focus on the requirements of additional support for young recipients to enable a flexible transition to surgeons, physicians and multi-disciplinary teams. The transition could be supported by moderating the process according to the needs of the recipient rather than focusing on the service specifications. The support that is provided to adolescents should involve appropriate training of the personnel such as surgeons, pharmacists, and physicians as well as the multi-disciplinary team members and psychosocial teams.
Method: The study was executed through a critical review of existing studies related to pharmaceutical interventions for controlling hyepertension. The critical review of the literature was conducted with references from sources such Journal of pediatric psychology, Pediatric transplantation, transplantation (Vandekerckhove et al., 2016).
Results: The structured report on the research question pertaining to quality of life of children after pediatric transplants was reflective of various aspects involved in the transplant regimen as well as with the behavioral and psychosocial implications for children (Parmar, Vandriel & Ng, 2017). The survival rates for children undergoing pediatric transplants were found to be influenced by the limited development of immune system and higher resistance to ABO mismatches.
The review also suggested that the use of appropriate levels of nutrition and sustainable medication were responsible for contributing to the growth of recipients after the transplants. Furthermore, the results derived from the review also emphasized on the crucial nature of transitioning to adolescence that can influence the longevity and quality of life for children following pediatric transplants.
The paper identified different factors that influence quality of life of children after pediatric transplants. The factors which were recognized from the research imply the nature and amount of nutrition provided to children, psychosocial support and effectiveness of change in treatment approaches according to age. Analysis of the findings also showed that the longevity of infants undergoing pediatric transplants was improved naturally by the lack of a completely developed immune system
Discussion: The systematic review of the literature available on the subject of the impact of pediatric transplants on the longevity and quality of life of infants was responsible for presenting distinct themes. The foremost theme was identified in the form of opportunities for favourable environment post-transplantation. The specific aspects to be considered in this theme were reflective of the favourite activities of the students at school, visiting places and unfavourable aspects of school among which the findings reflected on visiting places and participating in activities (Kim & Marks, 2014). The review depicted minimal restrictions for the activities desired by children in certain cases while the impact of the chronic conditions were also responsible for inducing limitations on activities such as horse riding and pursuit of a career in the army.
The second theme identified in the case of the impact of transplants on the quality of life of children was related to the involvement with family and friends that involve particular references to the emphasis on support from friends. The studies have depicted formidable references to the impact of psychosocial support from the immediate social circle in the adaptability of children to the concerns of post-transplantation. Some instances of parents supporting children through taking care of their medications and providing them with appropriate advice on dealing with the events after the transplantation can be accounted as a prolific factor that determines the betterment of quality of life of pediatric transplant recipients (Vandekerckhove et al., 2016). The interaction of children with family and friends were also associated with the concerns of bullying and consistent mockery that can be reflective of detrimental outcomes that can lead to detrimental consequences for children to cope with the effects post-transplantation.
The final theme identified in the systematic review was related to the experience of being a recipient of pediatric transplant that was primarily associated with the impact of the transplantation, medical issues experienced by the child and the transplant regimen. This theme also presented formidable references to the factors such as care of the body, underlying health problems and the effectiveness of the transplant team. It was found that the acceptance of children for the transplants as a significant experience in their lives could be accounted as a notable influence on the quality of life of individuals. Majority of qualitative studies have implied that the negative impact of the transplantation was observed only for a limited period of time and was particularly associated with the emphasis on cognitive maturity (Glotzbach, May & Wray, 2018).
The aspect of taking care of body after the transplant was profoundly associated with negative experiences particularly in terms of medical management. The concerns that were identified in this context were reflective of the fear and pain of removing pressure dressing, intravenous lines, phlebotomy and limitations on mobility which are attributed as primary reasons for affecting the quality of life of recipients after pediatric transplants (Vandekerckhove et al., 2016). The continuation of medication was also found to be a noticeable aspect that contributed to the quality of life after the transplant and was associated with varying behavioural implications among the recipients. The moderation of caloric intake as well as nutrition in complement with the medication results in setbacks for quality of life of children.
Ethical concerns: The sources of information selected for the systematic review were obtained from journals and qualitative studies conducted in context of the impact of pediatric transplants. Therefore the ethical concerns have been addressed properly for this research report.
Conclusion: The systematic review presented above could thus be associated with the conclusion that the quality and longevity of life of children undergoing pediatric transplants was dependent on psychosocial factors such as support from the immediate social circle as well as the factors of nutrition and calorie intake apart from the quality of treatment provided to the children.
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Kim, J. J., & Marks, S. D. (2014). Long-term outcomes of children after solid organ transplantation. Clinics, 69, 28-38.
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