Pediatric Transplantation

Post-traumatic stress symptoms are highly prevalent in the pediatric solid organ transplant population, as measured by the Child Trauma Screening Questionnaire. Risk factors for post-traumatic stress include recent ICU days, the number of medications, and involvement with the foster care system, whereas higher family functioning appears to be protective.

We aimed to compare differences in postoperative cardiopulmonary exercise test outcomes between pediatric patients who had an initial indication for transplant as structural congenital heart disease (CHD) versus cardiomyopathy (CM). Patients with cardiomyopathy performed better on chronotropic measures, which may be related to fewer pre-operative sternotomies.

Although pediatric organ donation represents a small proportion of overall organ donation, children and adolescents make a significant contribution to the pool of donated organs. In this study 252 solid organs were collected from children and adolescent. Two hundred and two recipients benefited from 62 pediatric organ donors, with a recipient/donor ratio of 3.3.

Left lobe split deceased grafts can achieve the same outcomes as live donor grafts and should be considered in an intention-to-split policy to decrease time on the waiting list for young children when a live donor is not available.

In this single-center study of 177 pediatric heart transplant recipients, 7% developed acute kidney injury requiring dialysis (AKI-D), with increased cardiopulmonary bypass time and higher weight at transplant associated with higher odds of AKI-D. AKI-D was associated with greater mortality during initial hospitalization and lower kidney failure-free survival.

This retrospective observational study in patients following liver transplantation showed an increased risk of SSI if abdominal patch is present. Choice of perioperative prophylaxis was not associated with risk reduction but duration of perioperative antibiotic prophylaxis slightly lowered the risk of SSI within the first 7 days.

Italy lacks an active pDCDD program. To gauge acceptance and anticipate reactions, we surveyed PICU staff attitudes before its launch. Despite limited knowledge, respondents expressed positive attitudes toward pDCDD, supporting Italian legislation on cardiocirculatory death determination and the “dead donor role.”

Examining social determinants of health in pediatric ventricular assist device recipients, the study identifies race, rather than childhood opportunity or insurance status, as a significant factor influencing outcomes.

In the current era, VADs reduce waitlist mortality in children who wait ≥90 days for a heart transplant, but there may be differential effects based on race, size, and VAD type.

COVID-19 in children following HSCT is frequently asymptomatic/mild. Nonetheless, 12% of patients have such severe disease that they need intensive care. Adverse outcomes are expected in mismatched HSCT, lymphopenia, LRTD, and MIS-C.

One in five children needing liver transplantation will experience a pathological fracture. Patients with low weight and height z-scores and a significant delay in bone age are at increased risk. Nutritional support remains important, even if to date it cannot fully counteract the risks of pathological fracture.

Pediatric patients with rejection show higher levels of circulating df-cfDNA compared to adults. The study supports using this cfDNA assay and specific cut points in pediatric and adult heart transplant patients with acceptable performance.