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.