Pediatric Transplantation

Heart transplantation remains an effective therapy in children with a growing number of long-term survivors. Risk factors for mortality in patients ≤ 10 years of age at transplant with conditional survival to 3 years post-transplant include CAV, rejection, malignancy, female sex, and Black race.

Young adults who initiate dialysis before 18 years old are disadvantaged by current OPTN waitlist and organ allocation policies for kidney transplantation. Compared to adolescents and other young adults, these patients spend the longest time on dialysis, have the highest incidence of waitlist removal without transplant, and have the worst graft survival after kidney transplantation.

Tracheostomy after listing for pediatric cardiac transplantation is a safe adjunct to assist progress. We show minimal side effects and no difference in survival between those with tracheostomy and those without over the full follow-up period.

Living donor liver transplantation (LDLT) is associated with improved survival in patients with biliary atresia aged < 2 years; however, socioeconomic differences exist between LDLT and non-LDLT recipients. Efforts to promote early equitable referral to centers offering LDLT are essential for improving outcomes in young children with biliary atresia.

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.

Congenital anomalies of kidney and urinary tract (CAKUT) are a common cause of the kidney failure in childhood, and these patients are more predisposed to developing graft reflux in the post-transplant period. A comparative analysis between patients with and without reflux in the graft was made to access the impact on patient's survival.

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.

In a review of a national database spanning the past three decades, researchers investigated delayed graft function (DGF) in pediatric recipients of deceased donor kidney transplants. This study found that DGF was associated with reduced survival after cases and controls were matched across various donor, recipient, and transplant factors.

Following liver transplant, 23% of pediatric recipients required rehospitalization within 30 days. Shorter hospital stays were a major risk factor for early hospital readmission, highlighting that longer initial transplant hospital stays may be beneficial for predischarge optimization and coordination of their complex care.

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.

LT is currently the only curative treatment for HCC that offers satisfactory long-term survival. We suggest exploring an expansion of the guidelines to favor LT over LR in pediatric HCC cases.

Intestinal complications (IC) are significant adverse events following liver transplantation (LT), yet research on pediatric cohorts remains limited. This study aims to describe IC in children after LT and identify factors associated with their occurrence. Recognizing these factors may help medical teams diagnose IC earlier in pediatric LT patients, leading to improved 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.