Pediatric Transplantation

In pediatric heart transplant recipients, there is a higher incidence of cytomegalovirus if ALC ≤ 0.3 × 10⁹ cells/L during induction, regardless of serostatus. Low ALC levels during induction may identify a high-risk group that could benefit from an altered CMV prophylactic regimen.

ATG induction is associated with decreased mortality and PTLD, but increased risk of organ rejection. Despite no differences in induction for the rate of graft failure and CMV, the decreased rate of mortality and PTLD with ATG induction may support its use in the optimal induction regimen for pediatric liver transplantation.

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.

It is crucial to consider kidney function and the exposure to valganciclovir vs. dose alone when determining the risk of neutropenia in pediatric solid organ transplant recipients. Utilizing BSA-based dosing, Cystatin C-based GFR estimation, and appropriate upper limits of GFR for age was associated with a lower rate of neutropenia.

Cardiac allograft tissue concentrations of tacrolimus and mycophenolate acid are correlated with blood levels, whereas those of everolimus showed no correlation. Further, the tissue perfusion efficiencies of tacrolimus and everolimus decreased with age. The relationship between acute cellular rejection and cardiac tissue concentrations could not be elucidated in this study.

After review of suspected EBV-driven Post-Transplant Lymphoproliferative Disorders (PTLD), according to the WHO 2022 criteria, the incidence was 11.7% in our cohort. Non-destructive PTLD was the most common subtype. Spatial/temporal heterogeneity required multiple biopsies. mTOR inhibitors were well tolerated. A diagnostic algorithm was developed to enhance the management of PTLD.

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.