Pediatric Transplantation

To better understand the immunosuppression requirements for patients receiving partial heart transplants (PHTs), we investigated the effect of rejection episodes on the aortic and pulmonary valves of patients who received orthotopic heart transplants (OHTs). Compared to patients with no rejection, those who experienced rejection episodes had no clinically significant changes to their pulmonary or aortic valves. Knowing that rejection primarily targets the myocardium and spares the valve, intensive immunosuppression regimens required for graft protection in OHT may not be necessary for semilunar valve protection in PHT.

This study highlights the low approach rates for potential organ donors and the persistent racial disparities in the pediatric deceased organ donation process. Racial minority groups are less likely to be approached for donation and consent compared to Whites. These findings underscore the need for an equitable organ donation process to expand the pediatric donor pool.

This study analyzed 225 pediatric heart transplants performed over a decade in Iran. The 1-year, 3-year, and 5-year survival rates were 85.7%, 79.7%, and 73.9%, respectively. Key mortality risk factors included donor age (HR: 1.04, p=0.03), male donor gender (HR: 2.04, p=0.05), and rituximab treatment (HR: 2.44, p=0.05). These findings provide insights for improving pediatric heart transplant outcomes.

Sibling (ages 12–17 years) of kidney and liver transplant recipients affirm that the transplant event is distressing and impacts their relationships and family functioning both in the moment and for years after the transplant. Transplant team members can support siblings through healthcare interactions and a family-inclusive model of care.

Biliary strictures management costs were highest in patients requiring treatment for recurrence or surgical biliary revision and lowest earlier post-transplant, suggesting that more aggressive management upfront may optimize costs. Future work will explore practice variation and cost-effective strategies to achieve OBO.

Tacrolimus clearance (CL/F) varies with hemoglobin and cholesterol levels in pediatric kidney transplant recipients, as shown in this retrospective study. Lower hemoglobin increases CL/F, while higher cholesterol reduces it, underscoring the potential for biochemical parameters to enhance therapeutic drug monitoring and dosing strategies.

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.

Rapid weight gain (RWG) in the first year following kidney transplantation occurred frequently in the North American Pediatric Trials and Collaborative Studies cohort and was significantly associated with obesity but not hypertension up to 5 years post-transplant. RWG was lower in children who received steroid minimization protocols.

This study highlights that in pediatric kidney transplant recipients, absolute measured GFR is a more reliable indicator of stable allograft function than BSA-indexed GFR or eGFR, especially during periods of significant growth. This approach helps distinguish between normal growth-related changes and potential graft dysfunction.

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.

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.

This is the first national study to assess post-HTx educational priorities among adolescent HTx recipients, caregivers of pediatric HTx recipients, and pediatric HTx clinicians. Our data suggest that HTx recipients and caregivers place higher value on educational topics regarding daily life after transplant compared to clinicians.

Organ transplant coordinators face numerous challenges, such as consent-obtaining obstacles, exposure to violence, compassion fatigue, obsessive thoughts, social disruption, and hard work in shadow. The pressure from these challenges can result in job burnout and turnover, leading to additional costs for healthcare systems and ultimately reducing the organ donation rate.