Pediatric Transplantation

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.

This study describes the incidence and clinical characteristics of Cytomegalovirus (CMV) reactivation in children undergoing hematopoietic stem cell transplantation (HSCT) in Colombia. Among 166 pediatric recipients, CMV viremia occurred in 28% of patients within 100 days post-transplant, with no significant differences in reactivation rates or treatment outcomes based on donor type. One-year overall survival was 60%, and CMV reactivation did not negatively impact survival outcomes. The findings highlight the need for further research to refine monitoring strategies, particularly in regions using unmanipulated stem cells with PTCy.

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.

An analysis of 98 children with kidney transplants from the Immune Development of Pediatric Transplantation (IMPACT) Trial was conducted to determine the relationship between NK cell phenotypes with infection, alloreactive events, and patient/allograft survival. NK cell phenotypes may be a useful tool to differentiate between infectious and alloimmune events.

This study introduces a novel approach to assess failure to rescue (FTR) rates in pediatric living donor liver transplantation (LDLT). By analyzing specific complications and their impact on patient and graft outcomes, the authors provide valuable insights for improving quality of care in this challenging surgical field.

The results support the policy of avoiding HLA combinations that preclude immune recognition of graft lymphocytes as foreign to decrease the risk of GVHD after living donor liver transplantation.

Haploidentical stem cell transplants are promising but should be restricted to leukemia patients first, then benign conditions. Avoid in DSA-positive patients to prevent graft rejection. Use bone marrow as the primary stem cell source to reduce the risk of GVHD.

Oral mucositis (OM) severity and its impact on changes in body weight are not extensively studied in pediatric patients who have received hematopoietic stem cell transplantation. Busulfan conditioning and methotrexate plus cyclosporin for graft-versus-host disease prophylaxis are the main contributors to OM in patients with nonmalignant and malignant conditions, respectively.

Varicella-zoster virus (VZV) reactivation is the most common infectious complication in the late posthematopoietic stem cell transplantation (HSCT) period and is reported as 16%–41%. Acyclovir prophylaxis is recommended for at least 1 year after HSCT to prevent VZV infections. However, there is less information on pediatric patients and studies on the most appropriate prophylaxis are ongoing.

Retrospective analysis of whole body DXA scans performed in children with end stage chronic liver disease before and after liver transplantation (LT) showed that sarcopenic patients stayed longer in hospital after LT, fat mass was preserved in all patients, and sarcopenia mostly recovered by 4 years after LT.

This multi-center survey of 64 pediatric nephrologists shows that probiotics are being increasingly prescribed to pediatric kidney transplant recipients for various indications, including antibiotic-associated diarrhea, Clostridium difficile infection, and recurrent urinary tract infections. However, significant variations in practice exist, with a lack of safety data being the main deterrent.

In autologous patients, transplant-related mortality (TRM) was 0%, with 4 (57%) experiencing disease relapse, resulting in the death of one patient. Additionally, 3 (42.8%) of patients remain alive under second-line management. The overall survival rate was 6 (85.7%), and the disease-free survival rate was 16 (88%). In allogeneic patients, TRM was 5.5% (1/18). One allogeneic patient experienced disease relapse and subsequently died. The overall survival rate and disease-free survival rate were 16 (88%). The objective of this study was to assess the outcomes of pediatric hematopoietic stem cell transplantation (HSCT) patients who have undergone transplantation thus far.

Hyperkalemia and hyponatremia in HSCT and solid organ transplant recipients should alert the clinician for CNI-related side effects; renin and aldosterone should be measured. Hyporeninemic hypoaldosteronism is the suggested underlying mechanism.