Pediatric Transplantation

This study surveyed pediatric infectious diseases (PID) clinicians about organ acceptance and associated posttransplantation interventions using fictitious case scenarios. Agreement on donor acceptance was high across many scenarios. However, management variability reveals key opportunities to optimize strategies to reduce the impact of donor-derived infections in organ recipients.

Machine learning identified key predictors of pediatric heart transplant waitlist mortality, including candidate-specific factors (e.g., diagnosis, ventilator use) and institutional practices (e.g., organ refusal rates). Centers with high refusal rates had worse outcomes, highlighting the need to standardize organ acceptance criteria and address modifiable risk factors to improve survival.

Partial heart transplant grafts remain viable during prolonged cold preservation, far exceeding traditional heart transplant ischemia limits. This breakthrough could revolutionize transplant logistics, enabling wider donor access and reducing wait times for life-saving, growth-capable heart valve implants.

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.

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.

In a review of a national database spanning the past three decades, researchers investigated delayed graft function (DGF) in pediatric recipients of deceased donor kidney transplants. This study found that DGF was associated with reduced survival after cases and controls were matched across various donor, recipient, and transplant factors.

Change in allocation of kidneys from pediatric deceased donors before the amendment (PRE) and after the amendment (POST). The proportion of pediatric deceased donor kidneys matched to pediatric recipients increased significantly from 14.7% before the amendment to 90.8% after the amendment.

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.

We retrospectively reviewed 115 pediatric HT recipients to evaluate the clinical applicability of the rejection risk score described by Butts et al. by comparing early rejection episodes of pediatric HT recipients and the number of EMB performed at our center before and after use of the score. With utilization of the score, our center decreased the frequency of EMB by 60% in the first-year post-transplant without worsening early post-transplant outcomes.