Success of transition to adult care in patients with pediatric-onset chronic liver disease.

OBJECTIVES

Previous studies on chronic pediatric-onset conditions have highlighted the risks of loss to follow-up, disease progression, or therapeutic nonadherence during transition. However, very few studies have focused on liver diseases. We aimed to evaluate the rate of successful transition in a cohort of patients with chronic liver disease, and assess its evolution over time and factors associated with transition failure.

METHODS

We conducted an observational, retrospective, monocentric study at our tertiary hospital. Ninety-three patients attending the pediatric hepatology clinic who were transferred to the adult-oriented hepatology clinic between 1997 and 2019 with at least 2 years of follow-up after transfer were included. Transition failure was defined as death, a history of poor medical office visit attendance, or complications due to therapeutic nonadherence within 2 years after transfer.

RESULTS

The prevalence of transition failure was 24%. Of this, poor attendance was 68% and complication was 32%, no deaths. The failure rate of transition decreased by almost 80% over time. A history of therapeutic nonadherence (odds ratio (OR) = 3.49; confidence interval (CI) 1.17-10.43, p = 0.03) and nonattendance to at least one pediatric consultation (OR = 2.76; CI 1.06-7.15, p = 0.04) in the year before transfer were the only risk factors for transition failure. Significantly more patients in the success group than in the failure group had met an adult-oriented hepatologist before transfer (31% vs. 9.1%, respectively, p = 0.04).

CONCLUSIONS

Transition was successful in more than three-quarters of our cohort and even improved over time.