Pediatric solid-organ transplantation is an increasingly successful treatment for solid-organ failure. With dramatic improvements in patient survival rates over the last several decades, there has been a corresponding emergence of complications attributable to pretransplant factors, transplantation itself, and the management of transplantation with effective immunosuppression. The predominant solid-organ transplantation sequelae are medical and psychosocial. These sequelae have a substantial effect on transition to adult care; as such, hurdles to successful transition of care arise from the patients, their families, and pediatric and adult health care providers. Crucial to successful transitioning is the ongoing development of a sense of autonomy and responsibility for one's own care. In this article we address the barriers to transitioning that occur with long-term survival in pediatric solid-organ transplantation. Although a particular transitioning model is not promoted, practical tools and strategies that contribute to successful transitioning of pediatric patients who have received a transplant are suggested.
Solid-Organ Transplantation in Childhood: Transitioning to Adult Health Care
GELATIN: My patient, who was recovering from surgery, was finally being advanced on her diet. In addition to water, she was allowed to eat Jell-O. With some fanfare, the little bright orange tub was dropped off in her room. With her parents and me watching, she eagerly scarfed down the jiggly, quivering, almost translucent mound of semi-solid water. What in the world was Jell-O other than a bad memory from my youth? Jell-O is fruit flavored gelatin. Gelatin is, according to an article in Saveur (2010; 131:36), an amazing food product. Derived from collagen in animal connective tissue, gelatin is one of several hydrocolloids, ingredients that can hold food in an unsteady solid. Other hydrocolloids include pectin (from fruits), agar-agar (from sea algae), and the products used by commercial food processors such as xanthan gum and sodium alginate. Gelatin is created by the partial hydrolysis of collagen that occurs following cooking or heating animal connective tissue. The collagen strands can rearrange, trap water, and hold food products in a high viscosity solution. In the 19th century, making collagen was a laborious process and involved boiling connective tissue and then clarification and straining of the resultant liquid. Because this process required a large staff, gelatin dishes were the mark of wealth. This changed in the late 19th century when gelatin could be made quickly and easily in powdered form. Now gelatin dishes could be made by almost anyone. In 1897 the Jell-O company introduced the combination of powdered gelatin and fruit flavoring, Jell-O, and an American classic was born. By the mid 20th century, gelatin was associated with being thrifty as almost any leftover food could be combined with the gelatin to make a tempting dish. While Jell-O never truly disappeared, most gelatin-based dishes, such as salads encased in gelatin, disappeared from American diets by the latter part of the 20th century. Gelatin, however, has made an amazing comeback in haute cuisine. Gelatin is central to the cooking of avant-garde cooks such as Spain's Ferran Adria, one of the most celebrated chefs in the world. His foam creations, copied all over the world, depend on gelatin. While I don't eat much Jell-O these days, and don't dare make foam, I do know that adding gelatin to my stews helps create a thick, luscious broth. Yum.
Noted by WVR, MD
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
Christopher LaRosa, Caryle Glah, H. Jorge Baluarte, Kevin E. C. Meyers; Solid-Organ Transplantation in Childhood: Transitioning to Adult Health Care. Pediatrics April 2011; 127 (4): 742–753. 10.1542/peds.2010-1232
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