Pediatric Transplantation

Liver transplantation (LT) significantly improves survival and quality of life for children with primary hyperoxaluria (PH), with favorable long-term outcomes observed in most patients. Despite reductions in urine oxalate levels, challenges such as graft shortages and renal graft loss persist, underscoring the need for ongoing monitoring and care.

This is a retrospective study to investigate the incidence and clinical prognosis of acute kidney injury and different modes of recovery after pediatric liver transplantation.

Our single-institution 15-year experience with simultaneous bilateral native nephrectomy (BNN) in pediatric patients demonstrates utility and safety. We discuss considerations of BNN relative to timing of transplantation, an area of conversation. We demonstrate that a minimally invasive approach is feasible, and the surgical approach should consider the route of current or planned dialysis.

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.

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 our single-center study, we retrospectively analyzed 50 patients who underwent liver transplantation with the diagnosis of IEM. The parental consanguinity rate was 74%. The mean age at liver transplantation was 75.3 ± 8.2 months (range: 5–218), with a follow-up period of 82.1 ± 10.2 months (range:1 day–229 months). Survival rates at 1, 5, 10, and 15 years were 83.7%, 81%, 81%, and 70.9%, respectively. Liver transplantation is an effective solution for children with IEM causing chronic organ failure and difficult to manage with medical treatment, showing good long-term prognosis.

ARD is prevalent among ESKD children. Younger age, lower BMI Z-scores, HTN, and increased Ca × Ph are risk factors for ARD. ARD frequency decreases on ≥ 6-month follow-up of patients.

Young adults who initiate dialysis before 18 years old are disadvantaged by current OPTN waitlist and organ allocation policies for kidney transplantation. Compared to adolescents and other young adults, these patients spend the longest time on dialysis, have the highest incidence of waitlist removal without transplant, and have the worst graft survival after kidney transplantation.

In a study of 42 patients with VOD, 50% were diagnosed with TA-TMA (5 clinically, 16 retrospectively). Survival rates at 1 year were 66.7% for VOD only, 60% for VOD+TA-TMA, and 62.5% for VOD+rTA-TMA (p = 0.9582). Understanding these endotheliopathies is vital for improving diagnosis, treatment, and patient outcomes.

Hispanic and non-Hispanic black (NHB) patients faced longer wait times for kidney transplantation compared to non-Hispanic whites (NHW), with NHB showing lower graft and patient survival. Key predictors of graft loss were identified, highlighting the need to mitigate disparities in wait times and clinical factors to improve outcomes.

Limited health literacy is common in pediatric kidney transplant recipients and families and is associated with increased frequency of hospital and outpatient clinic department visits early post-transplant.

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.