Pediatric Transplantation

To better understand the immunosuppression requirements for patients receiving partial heart transplants (PHTs), we investigated the effect of rejection episodes on the aortic and pulmonary valves of patients who received orthotopic heart transplants (OHTs). Compared to patients with no rejection, those who experienced rejection episodes had no clinically significant changes to their pulmonary or aortic valves. Knowing that rejection primarily targets the myocardium and spares the valve, intensive immunosuppression regimens required for graft protection in OHT may not be necessary for semilunar valve protection in PHT.

Significant gaps exist in pediatric transplant fellowship training, including immunosuppression management and long-term care. Our study identifies these areas through a global survey of 237 fellows and proposes actionable strategies, such as case-based learning and interdisciplinary collaboration, to enhance training and improve patient outcomes.

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.

Cidofovir (CDV) prophylaxis significantly reduces the incidence of BK virus-associated hemorrhagic cystitis in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation. Early BKV copy number reduction and lower graft-versus-host disease prevalence in the CDV group suggest its potential as an effective preventive treatment.

After review of suspected EBV-driven Post-Transplant Lymphoproliferative Disorders (PTLD), according to the WHO 2022 criteria, the incidence was 11.7% in our cohort. Non-destructive PTLD was the most common subtype. Spatial/temporal heterogeneity required multiple biopsies. mTOR inhibitors were well tolerated. A diagnostic algorithm was developed to enhance the management of PTLD.

Findings suggest that ChatGPT could be a useful tool for adolescents or caregivers to cover general aspects of kidney transplantation. While the overall scores of accuracy and relevancy are impressive, the presence of potentially risky outputs underscores the necessity for human oversight and validation.

The balance between activated Treg/T effector cells demonstrates potential as a minimally invasive immune monitoring metric that can be used to help identify chronic allograft inflammation in pediatric kidney transplant recipients. Identifying patients with chronic allograft inflammation can help inform earlier intervention and precision medicine.

Routine pretransplant PGx testing provides frequently actionable data to optimize posttransplant medication regimens, potentially avoiding adverse effects of medications including tacrolimus, azathioprine, HMG-CoA reductase inhibitors, and dapsone, while also providing important information related to thrombosis risk for VTE prophylaxis.

Our single-center retrospective study of pediatric patients following liver transplantation (pLT) found that hepatoblastoma (HB) patients had the most infectious events (IE) per patient and were more likely to develop fever & neutropenia than patients with biliary atresia or other hepatic diseases. Despite this finding, 1-and-5-year survival were not significantly different between patient groups. IE may inform specialized infection-related medical management driven by patients' underlying disease following pLT.