Pediatric Transplantation

In the current era, PJP remains a rare post-transplant complication in pediatric SOT patients. PJP infections are associated with significant morbidity, mortality, and costs. Risk factors for PJP are young age at transplant and heart transplantation. An assessment of individual risk factors should be regularly performed to optimize prevention strategies.

Cardiac allograft tissue concentrations of tacrolimus and mycophenolate acid are correlated with blood levels, whereas those of everolimus showed no correlation. Further, the tissue perfusion efficiencies of tacrolimus and everolimus decreased with age. The relationship between acute cellular rejection and cardiac tissue concentrations could not be elucidated in this study.

After review of suspected EBV-driven Post-Transplant Lymphoproliferative Disorders (PTLD), according to the WHO 2022 criteria, the incidence was 11.7% in our cohort. Non-destructive PTLD was the most common subtype. Spatial/temporal heterogeneity required multiple biopsies. mTOR inhibitors were well tolerated. A diagnostic algorithm was developed to enhance the management of PTLD.

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.

Routine pretransplant PGx testing provides frequently actionable data to optimize posttransplant medication regimens, potentially avoiding adverse effects of medications including tacrolimus, azathioprine, HMG-CoA reductase inhibitors, and dapsone, while also providing important information related to thrombosis risk for VTE prophylaxis.

ARD is prevalent among ESKD children. Younger age, lower BMI Z-scores, HTN, and increased Ca × Ph are risk factors for ARD. ARD frequency decreases on ≥ 6-month follow-up of patients.

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.

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.

Liver transplantation in the treatment of HoFH partially helped our patients to reach the target LDL-cholesterol level after transplantation and did not prevent the development of cardiovascular disease.

Investigating pulmonary vein stenosis following heart transplantation in children, this is the largest study of its kind that examines the prevalence, risk factors, and interventions for post-transplant PVS at two large transplant centers.

Post-transplant norovirus diarrhea persists for a median of 16 days (IQR 6–41.5 days) with 30% of patients developing chronic diarrhea. Morbidity is high, including AKI in 53% of patients, reduction in immunosuppression 20%, and acute rejection in 8% within 6 months of diagnosis.

Tuberous sclerosis complex (TSC) is a disorder of the mammalian target of the rapamycin (mTOR) pathway associated with the development of multisystem tumors, including renal angiomyolipoma (AML). These renal tumors are benign by nature but locally invasive and carry a risk for progression of chronic kidney disease (CKD) to end stage kidney disease (ESKD). The frequency of subsequent renal transplantation in this population is largely uncharacterized, although single-center data suggests that 5%–15% of adult TSC patients are kidney transplant recipients.