The longitudinal impact of psychological functioning, medical severity, and family functioning in pediatric heart transplantation.

BACKGROUND: Few data are available on the longitudinal psychological functioning of patients after pediatric heart transplantation. The objective of this study was to determine whether pre-transplant psychological functioning, post-transplant medical severity, and family functioning relate to the psychological functioning of pediatric patients after heart transplantation. METHODS: The study included 23 patients who underwent heart transplantation between ages 3 and 20 years, survived at least 1 year after transplantation, and had been assessed previously after transplantation between 1993 and 1995. This study reports a second post-transplant assessment between 1999 and 2000. We assessed psychological functioning using the Children's Global Assessment Scale before and after heart transplantation. We assessed medical severity using the number of outpatient visits, hospitalizations, and biopsies and using the Side Effect Severity Scale. We used the Global Assessment of Family Relational Functioning Scale to rate family functioning. RESULTS: The majority of patients (15/23) were alive at the second follow-up. They had survived a median of 9.6 (6.1-12.9) years after transplantation. Similar to their first follow-up assessments, 73% demonstrated good psychological functioning after heart transplantation. Although we found no correlation between medical severity and post-transplant psychological functioning, we did find a significant correlation between family functioning during the first 2 years of transplantation and post-transplant emotional adjustment. CONCLUSIONS: The majority of children and adolescents have the capacity for healthy psychological functioning after heart transplantation. Nevertheless, ongoing psychological assessment and intervention is necessary for patients and their families who face pediatric heart transplantation because >25% probably will have emotional adjustment difficulties.     

Adherence to medication after liver transplantation in Scotland: a pilot study.

This study assessed adherence to medication after liver transplantation and consisted of 2 components: a retrospective audit involving the examination of the Scottish national database, and a preliminary study assessing psychological factors implicated in poor adherence. In order to first establish an idea of the extent of poor adherence within the Scottish liver transplant population, a retrospective audit was carried out on all patients (N = 435) who received transplants before November 2003. Adherence was assessed by attendance at follow-up clinic appointments, blood immunosuppressant levels, and episodes of cellular rejection. It was found that attendance and immunosuppressant levels were often suboptimal and that nonadherence may have contributed to retransplantation and death. Cellular (acute) rejection after 6 months was associated with higher mortality. Explanations as to why liver transplant patients may not take their medication as recommended were then explored in detailed psychological assessments of 33 liver transplant recipients. The results indicated that low self-reported patient adherence was related to greater concerns regarding the potential adverse effects of medication, and a stronger belief that medicines in general are harmful. In addition, the greater the effect the transplantation had on patients' lives and the more it affected them emotionally, the less adherent the patients were likely to be. The results highlight potential areas that, if confirmed in a larger study, might be targeted in a psychological intervention to improve patient adherence and thereby transplantation outcomes.     

Life after transplantation: new transitions in quality of life and psychological distress

Individuals with kidney failure often elect to undergo kidney transplantation because they believe that they will be more active and return a sense of normality to their lives with a functioning transplant. Therefore it is important to assess whether these objectives are being met. To do so, we can examine health-related quality of life (HRQOL) in transplant recipients. A number of tools have been used for this purpose, including general HRQOL instruments such as the 36-item short-form health survey (SF-36) and transplant-specific surveys such as the Kidney Transplant Questionnaire. In general, HRQOL assessments improve with transplantation in functional and physical domains. However, many factors actually influence HRQOL in a negative way, including comorbid conditions, kidney function per se, rejection episodes and hospitalizations, employment status, and adverse effects of medications. Perceived physical appearance, issues related to sexuality, stress, anxiety, and even guilt complicate the emotional and psychological landscape after transplantation. This constellation of factors may be predictive of posttransplant life events, such as resumption of employment. Posttransplant HRQOL may be exceedingly important in understanding the issues related to adherence with treatment regimens, especially in the pediatric and adolescent transplant populations. HRQOL is now established as an important issue after transplantation. Nonetheless, shortcomings still exist in our ability to address HRQOL after transplantation. In particular, more study of patient-centered interventions is needed. The use of standardized methodologies for patient assessment could improve our ability to identify if such patient-centered interventions actually succeed across populations, and help us further address the panoply of factors encompassed within posttransplant HRQOL.     

Psychosocial Condition After Liver Transplantation in Children: Review of the Literature From 2006 to 2008

Pediatric liver transplantation is the treatment of choice for end-stage liver disease of various causes. With most patients surviving long term after surgery, questions and concerns nowadays focus on morbidity and quality of life. Characterizing health-related quality of life (HRQOL) after liver transplantation provides a more complete estimate of the overall health of liver transplant candidates and recipients.HRQOL remains, however, a wide concept, with various interpretations in the literature, varying from medical assessment of physical status to considering various nonmedical aspects. Among the former aspects, concerns are commonly addressed about physical health and the psychological and/or social functioning of both transplanted children and their families.This detailed review of the most relevant papers analyzing of HRQOL after pediatric liver transplantation published between January 2006 and September 2008 includes the psychosocial aspects in children/adolescents, parents, and/or family members after liver transplantation, emphasizing limitations inherent to “measuring” and analyzing HRQOL aspects.     

Relationship between sleep problems and health-related quality of life among pediatric liver transplant recipients

Among adult liver transplant recipients (LTRs), sleep disturbances and fatigue are common. Sleep problems following pediatric liver transplantation may contribute to daytime fatigue and lower health-related quality of life (HRQOL). The aim of this cross-sectional study was to determine the impact of sleep problems on the HRQOL of pediatric LTRs using validated measures. Participants included 47 LTRs. Mean age of the LTRs was 10.9 ± 4.6 years, and mean time since transplantation was 6.2 ± 3.9 years. The primary indication for transplantation was biliary atresia (51%). According to parent reports, pediatric transplant recipients had symptoms of sleep-disordered breathing, excessive daytime sleepiness, daytime behavior problems, and restless legs; 40.4% of parents and 43.8% of children reported significantly lower total HRQOL for the recipients. Age, time since transplantation, and health status were not significantly related to the quality of life. Hierarchical regression analyses revealed that the sleep-disordered breathing subscale of the Pediatric Sleep Questionnaire accounted for significant variance in parent-proxy reports on the Pediatric Quality of Life (PedsQL) summary scales measuring children's psychosocial health (R(2) = 0.36, P < 0.001), physical health (R(2) = 0.19, P = 0.004), and total HRQOL (R(2) = 0.35, P < 0.001). Also, the sleep-disordered breathing subscale accounted for significant variance in the child self-reported school functioning scale (R(2) = 0.18, P = 0.03). Clinically significant sleep problems were more common among children with low total HRQOL. In conclusion, sleep problems were common in this cohort of pediatric LTRs and predicted significant variance in HRQOL. Prospective larger scale studies are needed to assess factors that contribute to sleep difficulties and low HRQOL in this population. The detection and treatment of significant sleep problems may benefit the HRQOL of pediatric LTRs.     

Adolescent Health-Related Quality of Life Following Liver and Kidney Transplantation

Health perceptions of adolescent transplant patients should be considered in providing appropriate healthcare. OBJECTIVES: (i) quantify health-related quality of life (HRQOL) in adolescent liver and kidney transplant patients, (ii) compare caregiver ratings of their children's HRQOL to adolescent self-reports and (iii) examine the relationship between HRQOL and disease-specific disability (DSD). Adolescent liver (n = 51) and kidney (n = 26) transplant recipients and caregivers were surveyed using the CHQ-CF87 and CHQ-PF50. DSD scores were calculated for each patient. The response rate was >70%. Adolescent's psychological and physical health was similar to a healthy population, but general health poorer (p = 0.0006). Caretakers reported lower physical functioning and general health (p = 0.0001) but similar psychological health to a normative population. All caregivers expressed negative emotional impact of their child's health on themselves and family activities (p = 0.0001). Positive correlations were found between liver transplant recipients and caregivers: perceptions of behavior (ICC = 0.55, p < 0.001), mental health (ICC = 0.56, p < 0.001), self-esteem (ICC = 0.68, p 相似文献   

Allograft outcome following repeat transplantation of patients with non‐adherence‐related first kidney allograft failure: a population cohort study

Nonadherence is an important risk factor for premature allograft failure after kidney transplantation, but outcomes after re‐transplantation remain uncertain. Using data from the Australian and New Zealand Dialysis and Transplant registry, the associations between causes of first allograft failure and acute rejection‐related and non‐adherence‐related allograft failure following re‐transplantation were examined using competing risk analyses, treating the respective alternative causes of allograft failure and death with functioning graft as competing events. Fifty‐nine of 2450 patients (2%) lost their first allografts from nonadherence. Patients who lost their first kidney allograft from nonadherence were younger at the time of first kidney allograft failure but waited longer for a second allograft (>5 years: 54% vs. 20%, P < 0.001) compared with other causes. Compared with patients who lost their first allograft from causes other than nonadherence, the adjusted subdistribution hazard ratio (HR and 95% CI) for acute rejection‐related second allograft failure was 0.58 (0.08, 4.07; P = 0.582) for patients with allograft failure attributed to nonadherence and was 6.30 (1.34, 29.67; P = 0.020) for non‐adherence‐related second allograft failure. In this cohort of transplant recipients who have received second allografts, first allograft failure secondary to nonadherence was associated with a marginally greater risk of allograft failure attributed to nonadherence in subsequent transplantation.     

Medication adherence in chronic disease: issues in posttransplant immunosuppression

Poor medication adherence is a widespread problem that undermines the potential benefits of medical treatment. Typical adherence rates among chronic disease patients are approximately 50%, and these low adherence rates have a substantial economic impact, estimated at $100 to $300 billion annually. Nonadherence to immunosuppressants among transplant recipients is surprisingly frequent, and the consequences are serious. Among adult renal transplant patients, the median rate of nonadherence is approximately 22% and is associated with acute rejection episodes and approximately 36% of all graft losses. In the United States, nonadherence results in an estimated 903 episodes of acute rejection and 1319 renal transplants failures annually, costing approximately $15 million and $100 million, respectively. Drug regimen complexity is known to impact adherence. Research demonstrates an inverse relationship between dosing frequency and medication adherence in various chronic diseases, with once-daily dosing resulting in the highest adherence rates. Reducing the dosing frequency may positively impact both clinical and patient-reported outcomes, as well as health care costs. However, the increased costs of less frequently administered drugs must be outweighed by the net savings achieved through improved adherence rates and better health outcomes. If trends among patients with chronic diseases apply, once-daily dosing regimens may improve adherence rates by approximately 6% to 14% among renal transplant patients and could substantially reduce the number of acute rejection episodes and graft failures, although the exact economic impact is difficult to estimate. Further research into adherence issues in transplant patients and the potential clinical and economic benefits of once-daily dosing of immunosuppressants is warranted.     

Mealtime interactions in families of a child with cystic fibrosis: A meta-analysis

BackgroundA meta-analysis was performed to examine differences in family mealtimes between families with and without a child with CF. Both global measures of family functioning during the mealtime and parent-child micro behaviors specific to feeding were compared to determine if one class of mealtime behaviors is more strongly affected.MethodsOf 41 studies identified, 10 studies across 4 independent samples met the criteria for study inclusion. All studies included observational methodology. The mean sample age ranged from 18.6 months to 8 years and 6 months. The total aggregate sample size was 230 participants, 119 with CF and 111 comparison children.ResultsFamilies with children with CF encounter more difficulties during mealtimes than comparison families, and the effects on overall family functioning are greater than for parent–child micro feeding behaviors.ConclusionFindings suggest that future interventions should focus on the broader family context as well as behaviors specific to feeding.     

Health-related quality of life in children with Hirschsprung disease and children with functional constipation: Parent-child variability

BackgroundHealth-related quality of life (HRQOL) is an important outcome among children with Hirschsprung Disease (HD), but there are challenges in interpreting findings in previous studies owing to the choice of a comparator group and informant. We compared parent-proxy versus child self-report HRQOL in children with HD to children with functional constipation (FC) and examined predictors of HRQOL.MethodsData of 126 children (5–18 years, 60.3% male, HD: n = 52, FC: n = 74) were acquired from the Pediatric Colorectal and Pelvic Learning Consortium. Demographics, clinical variables, HRQOL (Pediatric Quality of Life Inventory parent-proxy; child self-report) and functional outcomes (Baylor Continence Scale, Cleveland Clinic Constipation Scoring System) were collected.ResultsParent and child HRQOL was similar for both cohorts, with higher scores on physical functioning and lower scores on emotional and school functioning. For children with HD, demographics and clinical variables did not predict HRQOL in multivariable regression models. For children with FC, greater severity of constipation predicted lower HRQOL (parent-proxy: B = -2.14, p < 0.001; child: B = -1.75, p = 0.001). Parent-child agreement on HRQOL scores was poor to moderate in the HD group (intraclass correlations (ICC)=0.38–0.74), but moderate to excellent in the FC group (ICC=0.63–0.84). Furthermore, parents of children with FC and ≤10 years overestimated children's HRQOL (proportional OR 4.59 (1.63, 13.85); p = 0.004).ConclusionClinical symptoms and demographic factors did not predict HRQOL among children with HD, highlighting the need to examine other biopsychosocial factors to understand long term HRQOL. Low parent-child HRQOL agreement in children with HD demonstrates the importance of obtaining parent and child perspectives.Level of evidenceIII.Type of studyPrognosis study.     

Predictors and Outcomes of Health‐Related Quality of Life in Caregivers of Cardiothoracic Transplant Recipients

Cardiothoracic transplant programs generally require that transplant recipients have family caregivers to assist them posttransplant. The burden of caregiving on the family members remains poorly understood. If caregivers’ well‐being is compromised by caregiving, it may bode poorly for transplant recipients’ own health in the long‐term posttransplant. We examined caregiver health‐related quality of life (HRQOL) during the first year after their family member's transplant, its predictors and its relationship to subsequent patient survival. Adult (aged 18+) caregivers of 242 cardiothoracic transplant recipients (lung = 134; heart = 108) completed assessments of demographics, psychosocial characteristics and caregiver burden at 2 months posttransplant, and HRQOL at 2, 7 and 12 months posttransplant. Recipients’ survival time was obtained from medical records. Caregiver HRQOL was generally high across the first‐year posttransplant in emotional and social functioning; caregiver physical functioning significantly worsened. There were no differences by type of recipient transplant. Greater caregiver burden predicted poorer caregiver HRQOL in several physical domains at 12 months posttransplant. Transplant recipients whose caregivers had lower perceived general health at 12 months posttransplant showed poorer survival rates during the subsequent 7 years of follow up. Transplant teams should identify those caregivers at risk for poorer general health posttransplant to maximize positive outcomes for the entire family.     

Evaluation of adherence and tolerability of prolonged‐release tacrolimus (Advagraf™) in kidney transplant patients in Germany: A multicenter,noninterventional study

This study assessed adherence to prolonged‐release tacrolimus (PR‐T)‐based immunosuppression during routine maintenance of renal transplant recipients in Germany. Patients had received PR‐T for ≥1 month at inclusion. Data were collected during four visits (V): baseline (V1), 6 (V2), 12 (V3), and 18 (V4) months. Composite primary endpoint: nonadherence at V4, defined as self‐reported nonadherence on the Basel Assessment of Adherence with Immunosuppressive Medication Scale (BAASIS^©), investigator‐rated nonadherence, and/or V4 tacrolimus trough level outside a predefined range. Secondary endpoints: individual BAASIS items, incidence of rejection, kidney function, and safety. Overall, 153 adult kidney recipients (mean [standard deviation] time post‐transplant 5.8 [4.6] years) were included. Nonadherence was high at V4 (67.7% [95% confidence interval 58.9%, 75.6%]). Medication‐taking adherence was 86.9% and 91.3% at V1 and V4, respectively; adherence to timing of medication intake was 58.2% and 58.3%, with little evidence of missed doses/drug holidays. Investigators rated adherence “good” in 85.6% of patients (V4). Two (1.3%) patients had acute rejection episodes. Kidney function remained stable (mean creatinine clearance, V1: 62.1 mL/min; V4: 65.3 mL/min). Investigators rated effectiveness of PR‐T as “very good”/“good” in 91.5% of patients. Most patients (94.7%) found PR‐T dosing more convenient than immediate‐release tacrolimus. PR‐T was well tolerated with high medication persistence.     

A molecular biopsy test based on arteriolar under‐hyalinosis reflects increased probability of rejection related to under‐immunosuppression

Calcineurin inhibitor immunosuppressive drugs induce changes such as arteriolar hyalinosis (ah) in kidney transplants, raising the possibility that molecular changes in biopsies related to histologic ah can provide information about drug exposure. We hypothesized that molecular changes associated with less‐than‐expected hyalinosis might highlight a subpopulation of patients with under‐immunosuppression/nonadherence at intermediate times of biopsy posttransplant (TxBx). Using gene expression data from 562 indication biopsies, we developed a molecular classifier for predicting the expected ah lesions (M_ah) at a particular TxBx. M_ah‐scores increased linearly with log(TxBx), but some biopsies had lower scores than expected for TxBx. The deviation of individual M_ah‐scores below the predicted regression line of M_ah‐scores vs TxBx is defined as “low hyalinosis index.” Low hyalinosis indices were frequent in biopsies between 3 months and 3 years posttransplant, particularly among biopsies lacking histologic hyalinosis (ah0), and were associated with T cell–mediated rejection and a subset of recent‐onset antibody‐mediated rejection without glomerular double contours. In patients with medical records available for review, low hyalinosis indices were frequently associated with physician‐recorded concerns about nonadherence (suspected or proven). We conclude that the M_ah classifier and hyalinosis index identify indication biopsies with rejection for which the possibility of patient nonadherence should be considered.     

Health status ten years after pediatric liver transplantation--looking beyond the graft

BACKGROUND: Little is known about long-term health after pediatric orthotopic liver transplantation (OLT). This study aimed to characterize the health status of recipients 10 years after OLT, with an emphasis on transplant-related morbidity and quality of life. METHODS: We performed a retrospective database review of 32 children who underwent OLT before October 1992 at one center and were alive after 10 years. Outcome measures were assessed 10 years after OLT. Cantril's self-anchoring scale was used for global quality of life assessment. RESULTS: Synthetic liver function at 10 years was preserved in all patients. The annual rate of episodes of acute rejection dropped markedly after the first year (1.4 at year 1 to 0.19 rejections/patient/year at year 10). Histologically confirmed chronic rejection developed in eight (25%) patients. At 10 years, long-term complications included mild to severe chronic renal failure (77%), mild chronic anemia (59%), and hypertension (25%). Significant growth retardation (z-score < -2), hyperlipidemia, and diabetes were uncommon. Infection requiring hospitalization occurred in 81% of the patients, with varicella zoster virus as the most common pathogen. Epstein-Barr virus-related malignancies affected 22% of patients. Ten-year survivors perceived quality of life as very good. Self-reporting of drug nonadherence by seven (22%) adolescents may have contributed to development of late onset rejection in this subgroup. Conclusions. Children who are 10-year survivors of OLT have excellent graft function and, despite chronic extrahepatic morbidities, a self-reported high quality of life.     

Child and family functioning 6 and 12 months after a serious pediatric fracture

BACKGROUND: Previous findings indicate that pediatric fractures can have adverse consequences for child adjustment and family functioning immediately after injury. However, longer term effects of the fractures are unknown. The purposes of the present prospective study were to examine the child and family outcomes of pediatric traumatic fractures at 6 months and 1 year after injury, and to identify injury and treatment factors associated with these outcomes. METHODS: We evaluated 57 children 6 to 12 years of age with traumatic fractures requiring hospitalization. Using standardized measures and parent interview, we obtained measures of pre- and postinjury child and family functioning. RESULTS: Although outcomes were primarily positive at 1 year after injury, child functional limitations and family stress were observed up to 6 months after injury. Lower extremity fractures had a more negative impact on families across all three assessment points. Children with fracture interventions that involved prolonged immobilization had more functional limitations at 6 months than children who were ambulatory. Family burden was higher at 1 month for the immobilized children, but not at later follow-up. CONCLUSION: Some children and families experience adverse effects during the year after a serious pediatric fracture, especially if sustained in a lower extremity. Fracture stabilization that allows for greater ambulation may offer some benefits related to functional outcomes and family impact.     

Health-related quality of life functioning over a 2-year period in children with end-stage renal disease

Background

Optimal care of the pediatric chronic kidney disease/end stage renal disease (CKD/ESRD) patient must now incorporate health-related quality of life (HRQOL) assessment and management.

Methods

This study reports the first data on longitudinal change in global (PedsQL^TM4.0) and disease-specific (PedsQL^TM3.0 ESRD Module) HRQOL pediatric ESRD patient and proxy ratings over four assessment periods spanning approximately a 2-year period. General linear mixed modeling was used to analyze associations between patient demographics, medical variables, and patient and proxy HRQOL scores.

Results

Self-reported and/or proxy data were available for at least two time-points for 53 patients (age 2–18 years; 60 % male), of whom 27 were receiving in-center hemodialysis.

Conclusions

Patient ratings on global health and physical activity, emotional, and social and disease-specific worry and communication domains were higher (i.e., better) than parent-proxy ratings, confirming the importance of obtaining both sources of information. Patients on dialysis longer, particularly females, reported worse emotional functioning; females also reported more physical appearance concerns. Parents rated older children and those on dialysis longer as functioning worse on multiple global and disease-specific (e.g., fatigue, relationship) domains. Parents also rated children as functioning increasingly worse in school over time. Further, patient ESRD history (acute onset vs. medically managed) impacted how parents viewed the burden of ESRD on their child over time.     

Identifying Subphenotypes of Antibody‐Mediated Rejection in Kidney Transplants

The key lesions in antibody‐mediated kidney transplant rejection (ABMR) are microcirculation inflammation (peritubular capillaritis and/or glomerulitis lesions, abbreviated “pg”) and glomerular double contours (cg lesions). We used these features to explore subphenotypes in 164 indication biopsies with ABMR‐related diagnoses: 137 ABMR (109 pure and 28 mixed with T cell–mediated rejection [TCMR]) and 27 transplant glomerulopathy (TG), identified from prospective multicenter studies. The lesions indicated three ABMR subphenotypes: pgABMR, cgABMR, and pgcgABMR. Principal component analysis confirmed these subphenotypes and showed that TG can be reclassified as pgcgABMR (n = 17) or cgABMR (n = 10). ABMR‐related biopsies included 45 pgABMR, 90 pgcgABMR, and 25 cgABMR, with four unclassifiable. Dominating all time intervals was the subphenotype pgcgABMR. The pgABMR subphenotype presented earliest (median <2 years), frequently mixed with TCMR, and was most associated with nonadherence. The cgABMR subphenotype presented late (median 9 years). Subphenotypes differed in their molecular changes, with pgABMR having the most histologic–molecular discrepancies (i.e. potential errors). Donor‐specific antibody (DSA) was not identified in 29% of pgcgABMR and 46% of cgABMR, but failure rates and molecular findings were similar to cases where DSA was known to be positive. Thus, ABMR presents distinct subphenotypes, early pg‐dominant, late cg‐dominant, and combined pgcg phenotype, differing in time, molecular features, accompanying TCMR, HLA antibody, and probability of nonadherence.     

Parent experiences and psychosocial support needs 6 months following paediatric critical injury: A qualitative study

IntroductionParents of critically injured children can experience high levels of psychological distress post-injury, however little is known about their experiences and needs following injury. This study aimed to explore parent experiences and psychosocial support needs in the six months following child critical injury.MethodsAn interpretive qualitative design was used. Semi-structured interviews were conducted with 30 parents of 23 critically injured children. Interviews explored parent experiences and psychosocial support needs. Qualitative data were managed using NVIVO 10 and analysed thematically.ResultsFour themes were identified: integrating back into home life; adjusting mentally and emotionally to injury; coping with injury as a family; and navigating resources to meet family needs. Parents and families experienced substantial ongoing emotional impacts at 6 months following child injury. Parents were unprepared for the negative changes in their child’s psychological wellbeing and behaviour post injury, and parents’ mental health was negatively impacted, with mothers more likely to seek emotional support than fathers. Parents reported receiving no psychosocial follow-up from the hospital and limited information about community services and accessing local community resources on returning home.ConclusionsThere is a need to include all family members in discharge planning, and to use a family-centred continuity-of-care approach from the time of child injury through to post-discharge recovery. To strengthen parent and family wellbeing, a biopsychosocial holistic approach is recommended, including cognitive-behavioural and other psychological strategies to help reduce distress for parents and all family members and strengthen their coping capacity. A dedicated family support coordinator role to facilitate care over the child recovery trajectory, and development of accessible online and e-psychosocial support resources for parents and families are recommended.     

Early acute cellular rejection: no effect on late hepatic allograft function in man

Whereas early acute cellular rejection, even if successfully treated, seems to have an impact on late function and survival of kidney and heart transplants, little quantitative data are available on its effect(s) on liver transplants. Routine liver function tests, the functioning liver cell mass (galactose elimination capacity) and microsomal metabolic capacity (aminopyrine breath test) were determined prospectively in 37 consecutive patients 1 year after liver transplantation. Of these, 19 (7 females and 12 males, 32–69 years of age) had previously required treatment for at least one biopsy proven acute cellular rejection episode occuring a median 7 days after grafting, while 18 (6 females and 12 males, 30–67 years of age) had not. The functioning liver cell mass and microsomal metabolic capacity were both within normal limits for the majority of patients and did not differ significantly between patients with and without previous acute cellular rejection episodes. In contrast to other solid organ transplants, early acute cellular rejection episodes do not affect late function of liver allografts in man. Received: 1 July 1998 Received in revised form 5 October 1999 Accepted: 12 October 1998     

Maternal Symptomatology and Parent–Child Relationship Functioning in a Diverse Sample of Young Children Exposed to Trauma

Children under the age of 6 years are disproportionately exposed to interpersonal trauma. Research describing type and frequency of exposure to trauma among this young population is limited. Additionally, few studies have assessed the role of multiple indicators of parental functioning on children's behavior following trauma exposure. The current study was conducted with 216 ethnically and socioeconomically diverse mother–child dyads to examine the impact of maternal symptoms and parent–child functioning on child's behavior after trauma exposure. Children experienced an average of over 5 traumatic events prior to age 6 years, and mothers had experienced an average of over 13 traumatic events during their lifetime. With child's trauma history in the model, maternal depressive symptomatology (β = .30) and parent–child dysfunction (β = .32) each uniquely accounted for variance in children's behavioral and emotional functioning. The findings of this study underscore the need for clinical interventions that address the parent–child relationship and parental symptomatology following young children's exposure to trauma.