Pediatric Transplantation

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.

Pediatric males experienced relative protection from acute rejection in liver, lung, and kidney transplantation compared to their female counterparts in our study. This analysis helps clarify the role of recipient sex as a nonmodifiable risk factor for acute rejection and assists clinicians in stratifying risk and personalizing immunosuppression regimens.

Female teenagers have lower survival following heart transplantation than their male counterparts. Male donor—female recipient transplants have the lowest survival among sex-matching groups. The use of organs from oversized or younger donors may be considered to help improve post-transplant survival in teenagers.

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.

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.

We aimed to compare differences in postoperative cardiopulmonary exercise test outcomes between pediatric patients who had an initial indication for transplant as structural congenital heart disease (CHD) versus cardiomyopathy (CM). Patients with cardiomyopathy performed better on chronotropic measures, which may be related to fewer pre-operative sternotomies.

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.

Italy lacks an active pDCDD program. To gauge acceptance and anticipate reactions, we surveyed PICU staff attitudes before its launch. Despite limited knowledge, respondents expressed positive attitudes toward pDCDD, supporting Italian legislation on cardiocirculatory death determination and the “dead donor role.”

Examining social determinants of health in pediatric ventricular assist device recipients, the study identifies race, rather than childhood opportunity or insurance status, as a significant factor influencing outcomes.

In the current era, VADs reduce waitlist mortality in children who wait ≥90 days for a heart transplant, but there may be differential effects based on race, size, and VAD type.