Langzeitbetreuung lebertransplantierter Kinder und Jugendlicher

 

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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.

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