Transition of care between paediatric and adult gastroenterology. Liver transplantation

With the increasing success of liver transplantation in children, a growing number of children are reaching an age when it is no longer appropriate for them to be followed by paediatricians. Clinicians looking after these liver allograft recipients need to be aware of the additional problems and needs in this group of young patients. While life after transplantation is usually near normal, a proportion of adolescents suffer from physical and psychological stresses that may result in social and behavioural problems. Non-compliance can have a major adverse impact on graft function. Immunosuppression needs to be adjusted to maintain good graft function, but also to keep to a minimum the adverse effects including renal failure and malignancy. The adverse cosmetic effects of some immunosuppressive drugs can be particularly troublesome at this stage in life. Overall, adolescent liver allograft recipients can have an excellent quality of life. Health care professionals need to be aware of the additional problems that this group of patients may have and they will need to adapt the follow-up in response to these issues.