Pediatric Transplantation

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.

Adolescent and young adult solid organ transplant recipients were prescribed once-daily tacrolimus. Once-daily tacrolimus was found to be safe and effective, it did not significantly improve adherence. Pill burden was not affected, and the financial burden was higher. It may be considered for select adolescent patients.

This manuscript will provide a brief review of current recommendations for contraception for adolescent and young adult solid organ transplant recipients, a short review of immunosuppression and pregnancy exposure, overview of outcomes in recipients who had a pregnancy before age 21 years, and pregnancy outcomes in the general transplant population.

Definitions for HAdV infection and diseases in pediatric patients with allo-HCT were developed and applied by CRCs for subjects with HAdV-positive PCRs. The application of definitions determined it feasible, reproducible, and can serve as a framework for outcomes of studies assessing the effectiveness of HAdV-targeted therapies.

One in five children needing liver transplantation will experience a pathological fracture. Patients with low weight and height z-scores and a significant delay in bone age are at increased risk. Nutritional support remains important, even if to date it cannot fully counteract the risks of pathological fracture.

Donor age is associated to the long-term functionality and growth of renal grafts in pediatric transplantation. Although better long-term results are obtained with grafts from donors older than 6 years, those younger than 6 years have good short-term and acceptable long-term results, making them a valid option for pediatric renal transplantation.

This study evaluated the association between prophylactic echinocandin and neurological complications after busulfan-containing conditioning regimens for stem cell transplantation. A lower incidence of neurological complications was observed in patients receiving prophylactic echinocandin, suggesting the impact of the choice of antifungal prophylaxis on busulfan neurotoxicity.

Leflunomide is a promising adjunctive treatment for BK virus eradication and prevention of BK nephropathy, along with IS reduction, particularly anti-proliferative immunosuppression reduction, without significant risk for the development of biopsy-proven rejection in pediatric kidney transplant recipients. Given the significant risk for the development of biopsy-proven rejection with complete AP discontinuation and CNI reduction in our study cohort, we suggest anti-proliferative reduction, not discontinuation, and judicious reduction in CNI trough goals with close monitoring as a strategy for treatment of BK viremia with concomitant use of leflunomide therapy.

Five paediatric kidney transplant recipients (median age 15 years) switched from immediate release tacrolimus (BD-tac) to extended-release tacrolimus (LCP-tac). Pharmacokinetic studies confirmed an extended release profile with longer time to maximum concentration (5 h) and lower maximum concentration (10 ng/mL). LCP-tac was better absorbed with 40% reduction in total daily dose.