Pediatric Transplantation

Patients with congenital heart disease (CHD) undergoing kidney transplant experience prolonged length of stay, increased risk for requiring prolonged mechanical ventilation, and posttransplant red blood cell transfusion. Overall, patients with CHD experienced similar long-term outcomes.

The findings of this study demonstrate that post-transplant rejection, infections, perceived medication necessity, and overall happiness significantly influence medication adherence among adolescent kidney transplant recipients. It is therefore recommended to introduce an early warning intervention system during home follow-ups, specifically designed to enhance medication adherence by addressing these critical factors.

Liver transplantation in patients with CHD and BA is safe. Although patients with CHD display heightened utilization of in-hospital resources, no discernible variance in long-term outcomes was observed.

This study highlights the low approach rates for potential organ donors and the persistent racial disparities in the pediatric deceased organ donation process. Racial minority groups are less likely to be approached for donation and consent compared to Whites. These findings underscore the need for an equitable organ donation process to expand the pediatric donor pool.

Pediatric males experienced relative protection from acute rejection in liver, lung, and kidney transplantation compared to their female counterparts in our study. This analysis helps clarify the role of recipient sex as a nonmodifiable risk factor for acute rejection and assists clinicians in stratifying risk and personalizing immunosuppression regimens.

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.

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.

In this prospective longitudinal serological survey of COVID-19 antibody in pediatric solid organ transplant recipients, we observed a detectable humoral response following two doses of COVID-19 mRNA vaccine and, importantly, with enhanced responses following additional doses of vaccine, as measured by multiple serologic assays.

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.

Living donor liver transplantation (LDLT) is associated with improved survival in patients with biliary atresia aged < 2 years; however, socioeconomic differences exist between LDLT and non-LDLT recipients. Efforts to promote early equitable referral to centers offering LDLT are essential for improving outcomes in young children with biliary atresia.

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.

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.

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.