Journal Article 小児肝移植後の保育園・幼稚園および小学校生活の実態

金澤 , 郁恵  ,  佐島 , 毅  ,  川島 , 瞳  ,  大久保 , 浩子  ,  上久保 , 毅  ,  金澤 , 寛之  ,  笠原 , 群生

52pp.352 - 359 , 2017-11 , 日本移植学会
【Objective】In pediatric liver transplants, not only will the continuous monitoring of physical status/growth catch-up/patient survival be necessary, but also the lifelong psychomotor development/quality of life will be essential in the recipients' long-term follow-up. The aim of the present study was to evaluate posttransplant school activities (nursery, preschool, and elementary) and validate the psychosocial support in each life stage of the recipients.【Methods】During the study period, 262 liver transplant recipients and their parents in the National Center for Child Health and Development, except for those patients aged over 18 and living abroad, were enrolled and participated in a survey assay using several modules, which measured general, disease-related, and family functions, including research in each school status.【Results】Responses from 173 among the 262 recipients and their parents (66.0%) were obtained. A total of 106 patients experienced entering school (nursery, 41, preschool, 71), though 38% of nursery students and 18% of preschool patients were denied entry to school because of their lack of knowledge about liver transplants and infectious complications with immunosuppression. Seventy-one patients experienced elementary school life, although 73% of them had general education, and 24% required special needs education because of developmental delay. The patients in special needs education class and 58% of the patients received liver transplants for metabolic liver disease. Regarding school activities during the field day, 72% of the patients needed no special assistance. However, 71% of the patients had impairment of activites during the school trip. Most parents described difficulties in regard to understanding patient conditions, including immunosuppression and the restriction of foods and of some school activities.【Conclusion】Our results also suggest that the necessity of long-term social support reduces social isolation to improve the health care of children who have had liver transplants.

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