Pediatric Transplantation

En bloc lung transplantation (EBLT) does not confer a survival advantage over bilateral sequential technique in the pediatric population. EBLT patients are less likely to develop airway ischemia and bronchiolitis obliterans syndrome. EBLT was also not found to be advantageous in the subgroup of patients <= 5 years of age.

The Pediatric Heart Transplant Society database was used to identify all children ≥ 2 years old with failing Fontan or cardiomyopathy who underwent isolated heart transplant 2005–2019. The primary endpoint was postoperative dialysis within the first 30 days. Fontan patients have a ~fivefold higher risk of dialysis compared to cardiomyopathy patients.

We analyzed a retrospective, observational cohort of 51 patients with pediatric acute liver failure with severe hepatic encephalopathy (grade III-IV), admitted between 1993 and 2023. The survival rate in patients with present PR was higher compared to patients with absent PR (70% and 29%, respectively). In the absence of PR, the neurological outcome could still be favorable after liver transplantation (LTx) (n = 3/6). Radiologically proven brain herniation was associated with mortality (6/7) or minimally conscious state (1/7), irrespective of undergoing a LTx or not.

Biliary strictures management costs were highest in patients requiring treatment for recurrence or surgical biliary revision and lowest earlier post-transplant, suggesting that more aggressive management upfront may optimize costs. Future work will explore practice variation and cost-effective strategies to achieve OBO.

Tacrolimus clearance (CL/F) varies with hemoglobin and cholesterol levels in pediatric kidney transplant recipients, as shown in this retrospective study. Lower hemoglobin increases CL/F, while higher cholesterol reduces it, underscoring the potential for biochemical parameters to enhance therapeutic drug monitoring and dosing strategies.

In October 2018, the OPTN changed adult heart transplant (HT) allocation policy, increasing the number of adult candidates that had higher priority than pediatric candidates, potentially disadvantaging pediatric waitlist registrants. Mortality on the waitlist decreased and access to HT for pediatric registrants did not decline following the policy change.

Rapid weight gain (RWG) in the first year following kidney transplantation occurred frequently in the North American Pediatric Trials and Collaborative Studies cohort and was significantly associated with obesity but not hypertension up to 5 years post-transplant. RWG was lower in children who received steroid minimization protocols.

Following liver transplant, 23% of pediatric recipients required rehospitalization within 30 days. Shorter hospital stays were a major risk factor for early hospital readmission, highlighting that longer initial transplant hospital stays may be beneficial for predischarge optimization and coordination of their complex care.

Pediatric HT recipients with decreased pre- and post-transplant functional status are at higher risk for graft failure and mortality. These patients may benefit from early intervention aimed at improving functional status.

This is the first national study to assess post-HTx educational priorities among adolescent HTx recipients, caregivers of pediatric HTx recipients, and pediatric HTx clinicians. Our data suggest that HTx recipients and caregivers place higher value on educational topics regarding daily life after transplant compared to clinicians.

This is the inaugural analysis of kidney graft survival in children, adolescents, and young adults in New Zealand to establish the impact of transfer from pediatric to adult nephrology services.