Skip to main content
SpringerLink
Log in

Long-Term Outcome and Transition

  • Chapter
  • First Online:
Pediatric Hepatology and Liver Transplantation

  • 1699 Accesses

Abstract

Paediatric liver transplantation has come a long way since the first transplant in 1963. Whereas outcome data two decades later are excellent, survival for young people is inferior to younger age groups, and protocol liver biopsies have shown evidence of fibrosis in up to half of the patients with normal liver function tests, and the impact of non-specific inflammation on further long-term graft survival is currently unknown. Complications related to immunosuppressive treatment remain prevalent, and adherence is a challenge for all patients, not only for adolescents and young adults. With better survival, the emphasis of care for children and young people post liver transplantation has shifted from survival to a more holistic care model including health-related quality of life and its related issues such as growth, puberty, cognition, education and mental health. This chapter will also address the challenges for young people and their families moving on from paediatric to adult-centred healthcare services and how a multidisciplinary approach can facilitate this process.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Starzl TE, Marchioro TL, Vonkaulla KN, Hermann G, Brittain RS, Waddell WR. Homotransplantation of the liver in humans. Surg Gynecol Obstet. 1963;117:659–76.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Martinelli J, Habes D, Majed L, Guettier C, Gonzales E, Linglart A, et al. Long-term outcome of liver transplantation in childhood: a study of 20-year survivors. Am J Transplant. 2018;18(7):1680–9.

    Article  CAS  PubMed  Google Scholar 

  3. Soltys KA, Mazariegos GV, Squires RH, Sindhi RK, Anand R, SPLIT Research Group. Late graft loss or death in pediatric liver transplantation: an analysis of the SPLIT database. Am J Transplant. 2007;7(9):2165–71.

    Article  CAS  PubMed  Google Scholar 

  4. Kelly D, Verkade HJ, Rajanayagam J, McKiernan P, Mazariegos G, Hubscher S. Late graft hepatitis and fibrosis in pediatric liver allograft recipients: current concepts and future developments. Liver Transpl. 2016;22(11):1593–602.

    Article  PubMed  Google Scholar 

  5. Ebel NH, Hsu EK, Berry K, Horslen SP, Ioannou GN. Disparities in waitlist and posttransplantation outcomes in liver transplant registrants and recipients aged 18 to 24 years: analysis of the UNOS database. Transplantation. 2017;101(7):1616–27.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Darcy A, Samyn M. Looking after young people with liver conditions: understanding chronic illness management in the context of adolescent development. Clin Liver Dis. 2017;9(5):103–6.

    Article  Google Scholar 

  7. Salt A, Noble-Jamieson G, Barnes ND, Mowat AP, Rolles K, Jamieson N, et al. Liver transplantation in 100 children: Cambridge and King’s College Hospital series. BMJ. 1992;304(6824):416–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Jain A, Singhal A, Fontes P, Mazariegos G, DeVera ME, Cacciarelli T, et al. One thousand consecutive primary liver transplants under tacrolimus immunosuppression: a 17- to 20-year longitudinal follow-up. Transplantation. 2011;91(9):1025–30.

    Article  CAS  PubMed  Google Scholar 

  9. Venick RS, Farmer DG, Soto JR, Vargas J, Yersiz H, Kaldas FM, et al. One thousand pediatric liver transplants during thirty years: lessons learned. J Am Coll Surg. 2018;226(4):355–66.

    Article  PubMed  Google Scholar 

  10. Kasahara M, Umeshita K, Sakamoto S, Fukuda A, Furukawa H, Sakisaka S, et al. Living donor liver transplantation for biliary atresia: an analysis of 2085 cases in the registry of the Japanese Liver Transplantation Society. Am J Transplant. 2018;18(3):659–68.

    Article  PubMed  Google Scholar 

  11. Busuttil RW, Farmer DG, Yersiz H, Hiatt JR, McDiarmid SV, Goldstein LI, et al. Analysis of long-term outcomes of 3200 liver transplantations over two decades: a single-center experience. Ann Surg. 2005;241(6):905–16; discussion 916–8.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Schoening WN, Buescher N, Rademacher S, Andreou A, Kuehn S, Neuhaus R, et al. Twenty-year longitudinal follow-up after orthotopic liver transplantation: a single-center experience of 313 consecutive cases. Am J Transplant. 2013;13(9):2384–94.

    Article  CAS  PubMed  Google Scholar 

  13. Kasahara M, Umeshita K, Inomata Y, Uemoto S, Japanese Liver Transplantation Society. Long-term outcomes of pediatric living donor liver transplantation in Japan: an analysis of more than 2200 cases listed in the registry of the Japanese Liver Transplantation Society. Am J Transplant. 2013;13(7):1830–9.

    Article  CAS  PubMed  Google Scholar 

  14. Dharnidharka VR, Lamb KE, Zheng J, Schechtman KB, Meier-Kriesche HU. Across all solid organs, adolescent age recipients have worse transplant organ survival than younger age children: a US national registry analysis. Pediatr Transplant. 2015;19(5):471–6.

    Article  PubMed  Google Scholar 

  15. Evans HM, Kelly DA, McKiernan PJ, Hubscher S. Progressive histological damage in liver allografts following pediatric liver transplantation. Hepatology. 2006;43(5):1109–17.

    Article  PubMed  Google Scholar 

  16. Neves Souza L, de Martino R, Sanchez-Fueyo A, Rela M, Dhawan A, O’Grady J, et al. Histopathology of 460 liver allografts removed at retransplantation: a shift in disease patterns over 27 years. Clin Transplant. 2018;32(4):e13227.

    Article  PubMed  Google Scholar 

  17. Fitzpatrick E, Dhawan A. Scanning the scars: the utility of transient elastography in young children. J Pediatr Gastroenterol Nutr. 2014;59(5):551.

    Article  PubMed  Google Scholar 

  18. Hingorani S. Chronic kidney disease after liver, cardiac, lung, heart-lung, and hematopoietic stem cell transplant. Pediatr Nephrol. 2008;23(6):879–88.

    Article  PubMed  PubMed Central  Google Scholar 

  19. LaRosa C, Baluarte HJ, Meyers KE. Outcomes in pediatric solid-organ transplantation. Pediatr Transplant. 2011;15(2):128–41.

    Article  PubMed  Google Scholar 

  20. Morath C, Opelz G, Dohler B, Zeier M, Susal C. Influence of blood pressure and calcineurin inhibitors on kidney function after heart or liver transplantation. Transplantation. 2018;102(5):845–52.

    Article  CAS  PubMed  Google Scholar 

  21. Filler G, Melk A, Marks SD. Practice recommendations for the monitoring of renal function in pediatric non-renal organ transplant recipients. Pediatr Transplant. 2016;20(3):352–63.

    Article  CAS  PubMed  Google Scholar 

  22. Schwartz GJ, Munoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol. 2009;20(3):629–37.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Zappitelli M, Parvex P, Joseph L, Paradis G, Grey V, Lau S, et al. Derivation and validation of cystatin C-based prediction equations for GFR in children. Am J Kidney Dis. 2006;48(2):221–30.

    Article  CAS  PubMed  Google Scholar 

  24. Samyn M, Cheeseman P, Bevis L, Taylor R, Samaroo B, Buxton-Thomas M, et al. Cystatin C, an easy and reliable marker for assessment of renal dysfunction in children with liver disease and after liver transplantation. Liver Transpl. 2005;11(3):344–9.

    Article  PubMed  Google Scholar 

  25. Aw MM, Samaroo B, Baker AJ, Verma A, Rela M, Heaton ND, et al. Calcineurin-inhibitor related nephrotoxicity-reversibility in paediatric liver transplant recipients. Transplantation. 2001;72(4):746–9.

    Article  CAS  PubMed  Google Scholar 

  26. Buell JF, Gross TG, Thomas MJ, Neff G, Muthiah C, Alloway R, et al. Malignancy in pediatric transplant recipients. Semin Pediatr Surg. 2006;15(3):179–87.

    Article  PubMed  Google Scholar 

  27. McLin VA, Allen U, Boyer O, Bucuvalas J, Colledan M, Cuturi MC, et al. Early and late factors impacting patient and graft outcome in pediatric liver transplantation: summary of an ESPGHAN monothematic conference. J Pediatr Gastroenterol Nutr. 2017;65(3):e53–9.

    Article  PubMed  Google Scholar 

  28. Gross TG, Orjuela MA, Perkins SL, Park JR, Lynch JC, Cairo MS, et al. Low-dose chemotherapy and rituximab for posttransplant lymphoproliferative disease (PTLD): a Children’s Oncology Group Report. Am J Transplant. 2012;12(11):3069–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Durand F. How to improve long-term outcome after liver transplantation? Liver Int. 2018;38(Suppl):134–8.

    Article  PubMed  Google Scholar 

  30. Rothbaum Perito E, Lau A, Rhee S, Roberts JP, Rosenthal P. Posttransplant metabolic syndrome in children and adolescents after liver transplantation: a systematic review. Liver Transpl. 2012;18(9):1009–28.

    Article  PubMed  Google Scholar 

  31. Perito ER, Lustig RH, Rosenthal P. Metabolic syndrome components after pediatric liver transplantation: prevalence and the impact of obesity and immunosuppression. Am J Transplant. 2016;16(6):1909–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. World Health Organization. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003.

    Google Scholar 

  33. Shemesh E, Shneider BL, Savitzky JK, Arnott L, Gondolesi GE, Krieger NR, et al. Medication adherence in pediatric and adolescent liver transplant recipients. Pediatrics. 2004;113(4):825–32.

    Article  PubMed  Google Scholar 

  34. Dobbels F, Van Damme-Lombaert R, Vanhaecke J, De Geest S. Growing pains: non-adherence with the immunosuppressive regimen in adolescent transplant recipients. Pediatr Transplant. 2005;9(3):381–90.

    Article  PubMed  Google Scholar 

  35. Christina S, Annunziato RA, Schiano TD, Anand R, Vaidya S, Chuang K, et al. Medication level variability index predicts rejection, possibly due to nonadherence, in adult liver transplant recipients. Liver Transpl. 2014;20(10):1168–77.

    Article  PubMed  Google Scholar 

  36. de Oliveira JTP, Kieling CO, da Silva AB, Stefani J, Witkowski MC, Smidt CR, et al. Variability index of tacrolimus serum levels in pediatric liver transplant recipients younger than 12 years: non-adherence or risk of non-adherence? Pediatr Transplant. 2017;21(8) https://doi.org/10.1111/petr.13058. Epub 2017 Oct 15.

    Article  CAS  Google Scholar 

  37. Shemesh E, Mitchell J, Neighbors K, Feist S, Hawkins A, Brown A, et al. Recruiting a representative sample in adherence research-The MALT multisite prospective cohort study experience. Pediatr Transplant. 2017;21(8) https://doi.org/10.1111/petr.13067. Epub 2017 Oct 6.

    Article  Google Scholar 

  38. Shemesh E, Duncan S, Anand R, Shneider BL, Alonso EM, Mazariegos GV, et al. Trajectory of adherence behavior in pediatric and adolescent liver transplant recipients: the medication adherence in children who had a liver transplant cohort. Liver Transpl. 2018;24(1):80–8.

    Article  PubMed  Google Scholar 

  39. Eaton CK, Gutierrez-Colina AM, Quast LF, Liverman R, Lee JL, Mee LL, et al. Multimethod assessment of medication nonadherence and barriers in adolescents and young adults with solid organ transplants. J Pediatr Psychol. 2018;43(7):789–99.

    Article  PubMed  Google Scholar 

  40. Considine A, Tredger JM, Heneghan M, Agarwal K, Samyn M, Heaton ND, et al. Performance of modified-release tacrolimus after conversion in liver transplant patients indicates potentially favorable outcomes in selected cohorts. Liver Transpl. 2015;21(1):29–37.

    Article  PubMed  Google Scholar 

  41. Kiberd JA, Acott P, Kiberd BA. Kidney transplant survival in pediatric and young adults. BMC Nephrol. 2011;12:54.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Harden PN, Walsh G, Bandler N, Bradley S, Lonsdale D, Taylor J, et al. Bridging the gap: an integrated paediatric to adult clinical service for young adults with kidney failure. BMJ. 2012;344:e3718.

    Article  CAS  PubMed  Google Scholar 

  43. Michaud PA, Suris JC, Viner R. The adolescent with a chronic condition. Part II: healthcare provision. Arch Dis Child. 2004;89(10):943–9.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Suris JC, Michaud PA, Viner R. The adolescent with a chronic condition. Part I: developmental issues. Arch Dis Child. 2004;89(10):938–42.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Viner RM, Forton JT, Cole TJ, Clark IH, Noble-Jamieson G, Barnes ND. Growth of long-term survivors of liver transplantation. Arch Dis Child. 1999;80(3):235–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Ee LC, Beale K, Fawcett J, Cleghorn GJ. Long-term growth and anthropometry after childhood liver transplantation. J Pediatr. 2013;163(2):537–42.

    Article  PubMed  Google Scholar 

  47. Loeb N, Owens JS, Strom M, Farassati F, Van Roestel K, Chambers K, et al. Long-term follow-up after pediatric liver transplantation: predictors of growth. J Pediatr Gastroenterol Nutr. 2018;66(4):670–5.

    Article  PubMed  Google Scholar 

  48. Mohammad S, Grimberg A, Rand E, Anand R, Yin W, Alonso EM, et al. Long-term linear growth and puberty in pediatric liver transplant recipients. J Pediatr. 2013;163(5):1354–60.e1–7.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Ee LC, Hill RJ, Beale K, Noble C, Fawcett J, Cleghorn GJ. Long-term effect of childhood liver transplantation on body cell mass. Liver Transpl. 2014;20(8):922–9.

    Article  PubMed  Google Scholar 

  50. Mass K, Quint EH, Punch MR, Merion RM. Gynecological and reproductive function after liver transplantation. Transplantation. 1996;62(4):476–9.

    Article  CAS  PubMed  Google Scholar 

  51. Janjua HS, Mahan JD. The role and future challenges for recombinant growth hormone therapy to promote growth in children after renal transplantation. Clin Transpl. 2011;25(5):E469–74.

    Article  CAS  Google Scholar 

  52. Stewart SM, Uauy R, Kennard BD, Waller DA, Benser M, Andrews WS. Mental development and growth in children with chronic liver disease of early and late onset. Pediatrics. 1988;82(2):167–72.

    CAS  PubMed  Google Scholar 

  53. Stewart SM, Hiltebeitel C, Nici J, Waller DA, Uauy R, Andrews WS. Neuropsychological outcome of pediatric liver transplantation. Pediatrics. 1991;87(3):367–76.

    CAS  PubMed  Google Scholar 

  54. Gilmour S, Adkins R, Liddell GA, Jhangri G, Robertson CM. Assessment of psychoeducational outcomes after pediatric liver transplant. Am J Transplant. 2009;9(2):294–300.

    Article  CAS  PubMed  Google Scholar 

  55. Sorensen LG, Neighbors K, Martz K, Zelko F, Bucuvalas JC, Alonso EM, et al. Longitudinal study of cognitive and academic outcomes after pediatric liver transplantation. J Pediatr. 2014;165(1):65–72.e2.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Afshar S, Porter M, Barton B, Stormon M. Intellectual and academic outcomes after pediatric liver transplantation: relationship with transplant-related factors. Am J Transplant. 2018;18(9):2229–37.

    Article  PubMed  Google Scholar 

  57. Rodijk LH, den Heijer AE, Hulscher JB, Verkade HJ, de Kleine RHJ, Bruggink JLM. Neurodevelopmental outcomes in children with liver diseases: a systematic review. J Pediatr Gastroenterol Nutr. 2018;67(2):157–68.

    Article  PubMed  Google Scholar 

  58. Srivastava A, Chaturvedi S, Gupta RK, Malik R, Mathias A, Jagannathan NR, et al. Minimal hepatic encephalopathy in children with chronic liver disease: prevalence, pathogenesis and magnetic resonance-based diagnosis. J Hepatol. 2017;66(3):528–36.

    Article  PubMed  Google Scholar 

  59. Kyrana E, Dhawan A. Minimal hepatic encephalopathy in children, uncommon or unrecognised? Time to act. J Hepatol. 2017;66(3):478–9.

    Article  PubMed  Google Scholar 

  60. Razek AA, Abdalla A, Ezzat A, Megahed A, Barakat T. Minimal hepatic encephalopathy in children with liver cirrhosis: diffusion-weighted MR imaging and proton MR spectroscopy of the brain. Neuroradiology. 2014;56(10):885–91.

    Article  PubMed  Google Scholar 

  61. Huda A, Newcomer R, Harrington C, Keeffe EB, Esquivel CO. Employment after liver transplantation: a review. Transplant Proc. 2015;47(2):233–9.

    Article  CAS  PubMed  Google Scholar 

  62. Huda A, Newcomer R, Harrington C, Blegen MG, Keeffe EB. High rate of unemployment after liver transplantation: analysis of the United Network for Organ Sharing database. Liver Transpl. 2012;18(1):89–99.

    Article  PubMed  Google Scholar 

  63. Parmar A, Vandriel SM, Ng VL. Health-related quality of life after pediatric liver transplantation: a systematic review. Liver Transpl. 2017;23(3):361–74.

    Article  PubMed  Google Scholar 

  64. Hames A, Matcham F, Joshi D, Heneghan MA, Dhawan A, Heaton N, et al. Liver transplantation and adolescence: the role of mental health. Liver Transpl. 2016;22(11):1544–53.

    Article  PubMed  Google Scholar 

  65. Supelana C, Annunziato RA, Kaplan D, Helcer J, Stuber ML, Shemesh E. PTSD in solid organ transplant recipients: current understanding and future implications. Pediatr Transplant. 2016;20(1):23–33.

    Article  CAS  PubMed  Google Scholar 

  66. Sawyer M, Azzopardi P, Wicknemarathne D, Patton G. The age of adolescence. Lancet. 2018;2(3):223.

    PubMed  Google Scholar 

  67. American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians-American Society of Internal Medicine. A consensus statement on health care transitions for young adults with special health care needs. Pediatrics. 2002;110(6 Pt 2):1304–6.

    Google Scholar 

  68. Blum RW, Garell D, Hodgman CH, Jorissen TW, Okinow NA, Orr DP, et al. Transition from child-centered to adult health-care systems for adolescents with chronic conditions. A position paper of the Society for Adolescent Medicine. J Adolesc Health. 1993;14(7):570–6.

    Article  CAS  PubMed  Google Scholar 

  69. Scal P. Improving health care transition services: just grow up, will you please. JAMA Pediatr. 2016;170(3):197–9.

    Article  PubMed  Google Scholar 

  70. Fair C, Cuttance J, Sharma N, Maslow G, Wiener L, Betz C, et al. International and interdisciplinary identification of health care transition outcomes. JAMA Pediatr. 2016;170(3):205–11.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Williams R, Alexander G, Aspinall R, Bosanquet J, Camps-Walsh G, Cramp M, et al. New metrics for the Lancet Standing Commission on Liver Disease in the UK. Lancet. 2017;389(10083):2053–80.

    Article  PubMed  Google Scholar 

  72. Sagar N, Leithead JA, Lloyd C, Smith M, Gunson BK, Adams DH, et al. Pediatric liver transplant recipients who undergo transfer to the adult healthcare service have good long-term outcomes. Am J Transplant. 2015;15(7):1864–73.

    Article  CAS  PubMed  Google Scholar 

  73. Cohen E, MacKenzie R, Yates G. HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth. J Adolesc Health. 1991;12(7):539.

    Article  CAS  PubMed  Google Scholar 

  74. Hames A, Malan J. Whose problem is it? Improving adherence in young adults. Rotterdam: Ethical Legal and Psychosocial Aspects of Transplantation (ELPAT) Congress; 2013.

    Google Scholar 

  75. Heldman MR, Sohn MW, Gordon EJ, Butt Z, Mohammed S, Alonso EM, et al. National survey of adult transplant hepatologists on the pediatric-to-adult care transition after liver transplantation. Liver Transpl. 2015;21(2):213–23.

    Article  PubMed  Google Scholar 

  76. Samyn M. Parents and carers of young people with liver transplantation: lost in transition? Pediatr Transplant. 2017;21(1) https://doi.org/10.1111/petr.12855. Epub 2016 Dec 15.

    Article  Google Scholar 

  77. Schwartz LA, Tuchman LK, Hobbie WL, Ginsberg JP. A social-ecological model of readiness for transition to adult-oriented care for adolescents and young adults with chronic health conditions. Child Care Health Dev. 2011;37(6):883–95.

    Article  CAS  PubMed  Google Scholar 

  78. Bilhartz JL, Lopez MJ, Magee JC, Shieck VL, Eder SJ, Fredericks EM. Assessing allocation of responsibility for health management in pediatric liver transplant recipients. Pediatr Transplant. 2015;19(5):538–46.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Annunziato RA, Bucuvalas JC, Yin W, Arnand R, Alonso EM, Mazariegos GV, et al. Self-management measurement and prediction of clinical outcomes in pediatric transplant. J Pediatr. 2018;193:128–133.e2.

    Article  PubMed  Google Scholar 

  80. Coad J, Toft A, Claridge L, Ferguson J, Hind J, Jones R, et al. Using mobile phone technology to support young liver transplant recipients moving to adult services. Prog Transplant. 2017;27(2):207–18.

    Article  PubMed  Google Scholar 

  81. Joshi D, Gupta N, Samyn M, Deheragoda M, Dobbels F, Heneghan MA. The management of childhood liver diseases in adulthood. J Hepatol. 2017;66(3):631–44.

    Article  PubMed  Google Scholar 

  82. Dhawan A, Samyn M, Joshi D. Young adults with paediatric liver disease: future challenges. Arch Dis Child. 2017;102(1):8–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Paediatric Liver, GI and Nutrition Centre, King’s College Hospital NHS Foundation Trust, London, UK

    Marianne Samyn

Authors
  1. Marianne Samyn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marianne Samyn .

Editor information

Editors and Affiliations

  1. Paediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII Bergamo, Bergamo, Italy

    Lorenzo D'Antiga

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Samyn, M. (2019). Long-Term Outcome and Transition. In: D'Antiga, L. (eds) Pediatric Hepatology and Liver Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-96400-3_37

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-96400-3_37

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-96399-0

  • Online ISBN: 978-3-319-96400-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation