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Jenifer R. Lightdale, MD; Christine L. Mudge, RN; Nancy L. Ascher, MD, PhD; Philip Rosenthal, MD

Arch Pediatr Adolesc Med. 1998;152:797-802.

ABSTRACT
Objective  To examine the role of pediatricians in posttransplantation care of pediatric liver transplant recipients.

Design  Written survey of parents and pediatricians of children enrolled in a pediatric liver transplant program.

Setting  Questionnaires were mailed from a liver transplant center (LTC), set in a university-affiliated, tertiary-care medical center, to the homes of families and the offices of pediatricians in a variety of urban, suburban, and rural locales worldwide.

Study Population  Eighty-four percent of families and 81% of pediatricians who met study criteria participated.

Results  Only 8.9% of all pediatricians reported feeling comfortable providing all care for their liver transplant patients, while 82.2% were most comfortable sharing responsibility for care with the LTC. The remaining 8.9% of pediatricians were most comfortable with the LTC providing care. The more comfort pediatricians reported in providing care, the more likely parents were to report contacting pediatricians for medical problems. The more comfort pediatricians reported, the more parents perceived that (1) pediatricians and the LTC work well together (P<.03); (2) the LTC is informed about their child (P<.001); and (3) pediatricians are similarly up-to-date (P<.001). Furthermore, the more comfort pediatricians felt, the more parents believed that the liver transplant improved their child's health (P<.03) and that their child enjoys school (P = .08). Of the pediatricians, 15.6% who reported attending a continuing medical education course were significantly more comfortable (P = .05). The 18.9% of participating pediatricians who reported receiving some training in pediatric gastroenterology were also significantly more comfortable caring for children with liver transplants (P<.05).

Conclusion  Increasing pediatrician comfort levels in providing posttransplantation care for children with liver transplants is critical to the continuing success of pediatric liver transplantation.

From the Departments of Pediatrics (Drs Lightdale and Rosenthal) and Surgery (Drs Ascher and Rosenthal) and the Pediatric Liver Transplant Program (Ms Mudge and Drs Ascher and Rosenthal), University of California, San Francisco.

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