Pediatric Transplantation

When pediatric kidney transplant recipients were compared based on the achievement (or not) of a CD3+ T-cell count < 25 cells/mm³ following rabbit anti-thymocyte globulin induction, there were no differences in infectious or graft outcomes by 12-months post-transplant.

In the current era, PJP remains a rare post-transplant complication in pediatric SOT patients. PJP infections are associated with significant morbidity, mortality, and costs. Risk factors for PJP are young age at transplant and heart transplantation. An assessment of individual risk factors should be regularly performed to optimize prevention strategies.

It is crucial to consider kidney function and the exposure to valganciclovir vs. dose alone when determining the risk of neutropenia in pediatric solid organ transplant recipients. Utilizing BSA-based dosing, Cystatin C-based GFR estimation, and appropriate upper limits of GFR for age was associated with a lower rate of neutropenia.

This study investigated the incidence of allograft rejection and de novo donor-specific antibody formation following COVID-19 vaccination or infection among pediatric kidney transplant recipients.

The recurrence rate was high in pediatric patients with PSC, emphasizing the need for tailored management strategies in children. The association between recurrent PSC and immune-activating conditions, including ACR and IBD, suggested that immune modulation strategies should be a priority in recurrence prevention.

Baseline immune evaluation can assist in decisions for additional protective measures before transplant (avoidance of live vaccines, antimicrobial prophylaxis) and decrease the uncertainties in the evaluation of inborn errors of immunity after transplant. Ongoing work and developing standardized protocols for baseline immunologic work-up could improve reliability and comparability across different centers.

Investigating pulmonary vein stenosis following heart transplantation in children, this is the largest study of its kind that examines the prevalence, risk factors, and interventions for post-transplant PVS at two large transplant centers.

Post-transplant norovirus diarrhea persists for a median of 16 days (IQR 6–41.5 days) with 30% of patients developing chronic diarrhea. Morbidity is high, including AKI in 53% of patients, reduction in immunosuppression 20%, and acute rejection in 8% within 6 months of diagnosis.

Pediatric KTRs may be safely treated with alemtuzumab induction without increased acute rejection, delayed graft function, graft loss, or patient mortality, but with decreased CMV infection and 1 and 5 years hospitalization rates. Steroid maintenance is associated with decreased 5 years hospitalization and PTLD, but increased mortality.

This observational, retrospective investigation demonstrates temporal associations pointing to a reassuring vaccine safety profile and mild SARS-Cov-2 infectious phenotype in pediatric renal transplant recipients fully vaccinated against COVID-19.

D+R− serostatus is significantly associated with the development of monomorphic/polymorphic PTLD. Intensive follow-up of EBV viral load within 6-month post-transplant, especially for patients with D+R− and/or non-liver transplant recipients ≥5 years of age at transplant, may help detect monomorphic/polymorphic PTLD early in pediatric transplant.

Pediatric kidney transplant recipients given two doses of alemtuzumab induction immunosuppression, with steroid-free maintenance immunosuppression, had a ten-year living-donor graft survival of 86.5% and a deceased donor graft survival of 57.7%. The incidence of viral infections was similar to that reported in other cohorts, and growth improved after transplant.

An antifungal regimen of micafungin and nebulized amphotericin B liposomal may be useful at decreasing the duration of elevated liver enzymes in pediatric patients in the immediate post-lung transplant period when compared to voriconazole monotherapy.

In the largest pediatric kidney transplant recipient case series with EBV DNAemia given rituximab to prevent PTLD, rituximab achieved a short-term reduction in DNA load; however, recurrent DNAemia is common.

Excellent short- and long-term kidney transplant graft, gut transplant graft, and patient survival can be achieved through meticulous surgical technique and multidisciplinary peri-operative management of pediatric kidney after gut transplant recipients.