Pediatric Transplantation

This study surveyed pediatric infectious diseases (PID) clinicians about organ acceptance and associated posttransplantation interventions using fictitious case scenarios. Agreement on donor acceptance was high across many scenarios. However, management variability reveals key opportunities to optimize strategies to reduce the impact of donor-derived infections in organ recipients.

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.

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.

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.

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.

This study introduces a novel approach to assess failure to rescue (FTR) rates in pediatric living donor liver transplantation (LDLT). By analyzing specific complications and their impact on patient and graft outcomes, the authors provide valuable insights for improving quality of care in this challenging surgical field.

This study identifies missed opportunities for pre-solid organ transplant (SOT) varicella vaccination, particularly among infants and young children, underscores a gap in ensuring that pediatric SOT recipients have a defined pretransplant varicella-zoster virus (VZV) serostatus, and highlights the presence of VZV disease in the modern two-dose varicella vaccine era.

Oral mucositis (OM) severity and its impact on changes in body weight are not extensively studied in pediatric patients who have received hematopoietic stem cell transplantation. Busulfan conditioning and methotrexate plus cyclosporin for graft-versus-host disease prophylaxis are the main contributors to OM in patients with nonmalignant and malignant conditions, respectively.

Our study suggests that persistent nephrotic syndrome and a low rate of reduction in proteinuria may predict rapid progression to graft failure in nonresponders.

No associations were found between PIRCHE-II or HLA-EMMA and outcomes, but a trend toward increased odds of de novo donor-specific antibody formation with higher PIRCHE-II scores was noted. However, limited outcomes preclude definitive conclusions.