Pediatric Transplantation

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.

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.

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.

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.

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 is the inaugural analysis of kidney graft survival in children, adolescents, and young adults in New Zealand to establish the impact of transfer from pediatric to adult nephrology services.

In the current era, VADs reduce waitlist mortality in children who wait ≥90 days for a heart transplant, but there may be differential effects based on race, size, and VAD type.

In this large cohort of pediatric kidney transplant recipients with antibody mediated rejection, nearly one-third of patients experienced graft failure or significant graft dysfunction within 12 months of diagnosis. Poor graft function at time of diagnosis was associated with higher odds of graft failure.

In the largest pediatric kidney transplant recipient case series with EBV DNAemia given rituximab to prevent PTLD, rituximab achieved a short-term reduction in DNA load; however, recurrent DNAemia is common.

Excellent short- and long-term kidney transplant graft, gut transplant graft, and patient survival can be achieved through meticulous surgical technique and multidisciplinary peri-operative management of pediatric kidney after gut transplant recipients.

Kidney Paired Donation provides increased access to high quality living donor organs with possible immunologic, size, age, and logistic advantages for pediatric patients and should be encouraged.