Pediatric Transplantation

Bortezomib was well tolerated as an adjunctive therapy in four pediatric kidney transplant patients with refractory antibody-mediated rejection and persistent donor-specific antibodies and resulted in an overall statistically significant reduction in DSA MFI.

In autologous patients, transplant-related mortality (TRM) was 0%, with 4 (57%) experiencing disease relapse, resulting in the death of one patient. Additionally, 3 (42.8%) of patients remain alive under second-line management. The overall survival rate was 6 (85.7%), and the disease-free survival rate was 16 (88%). In allogeneic patients, TRM was 5.5% (1/18). One allogeneic patient experienced disease relapse and subsequently died. The overall survival rate and disease-free survival rate were 16 (88%). The objective of this study was to assess the outcomes of pediatric hematopoietic stem cell transplantation (HSCT) patients who have undergone transplantation thus far.

Adrenal insufficiency is common in pediatric kidney transplant recipients. Corticosteroid exposure is a risk factor, and medical complexity and kidney function lability are adverse clinical outcomes. These data support systemic clinical surveillance of adrenal insufficiency in pediatric kidney transplant recipients treated with corticosteroids.

Hyperkalemia and hyponatremia in HSCT and solid organ transplant recipients should alert the clinician for CNI-related side effects; renin and aldosterone should be measured. Hyporeninemic hypoaldosteronism is the suggested underlying mechanism.

Pediatric KTRs may be safely treated with alemtuzumab induction without increased acute rejection, delayed graft function, graft loss, or patient mortality, but with decreased CMV infection and 1 and 5 years hospitalization rates. Steroid maintenance is associated with decreased 5 years hospitalization and PTLD, but increased mortality.

Abstract of changes in thoracic radio density after living donor liver transplantation

This manuscript will provide a brief review of current recommendations for contraception for adolescent and young adult solid organ transplant recipients, a short review of immunosuppression and pregnancy exposure, overview of outcomes in recipients who had a pregnancy before age 21 years, and pregnancy outcomes in the general transplant population.

COVID-19 in children following HSCT is frequently asymptomatic/mild. Nonetheless, 12% of patients have such severe disease that they need intensive care. Adverse outcomes are expected in mismatched HSCT, lymphopenia, LRTD, and MIS-C.

Pediatric kidney transplant recipients given two doses of alemtuzumab induction immunosuppression, with steroid-free maintenance immunosuppression, had a ten-year living-donor graft survival of 86.5% and a deceased donor graft survival of 57.7%. The incidence of viral infections was similar to that reported in other cohorts, and growth improved after transplant.

Donor age is associated to the long-term functionality and growth of renal grafts in pediatric transplantation. Although better long-term results are obtained with grafts from donors older than 6 years, those younger than 6 years have good short-term and acceptable long-term results, making them a valid option for pediatric renal transplantation.

An antifungal regimen of micafungin and nebulized amphotericin B liposomal may be useful at decreasing the duration of elevated liver enzymes in pediatric patients in the immediate post-lung transplant period when compared to voriconazole monotherapy.

Assessment of pediatric heart transplant recipients demonstrated lower aerobic capacity and upper body muscle strength and endurance compared to healthy children. Our study suggests the wall sit test is a quick, easy tool that correlates with overall fitness and quality of life which could be utilized in clinical and research settings.

BFC regimen used in haploidentical SCT was administered safely without major transplant-related complications even in symptomatic patients, and neurological symptoms were stabilized after SCT.

In the largest pediatric kidney transplant recipient case series with EBV DNAemia given rituximab to prevent PTLD, rituximab achieved a short-term reduction in DNA load; however, recurrent DNAemia is common.

Excellent short- and long-term kidney transplant graft, gut transplant graft, and patient survival can be achieved through meticulous surgical technique and multidisciplinary peri-operative management of pediatric kidney after gut transplant recipients.

The humoral immune response to two doses of the SARS-CoV-2 BNT 162B2 vaccine in PKTRs is suboptimal compared to that in dialysis patients and PKTRs with hybrid immunity.

Leflunomide is a promising adjunctive treatment for BK virus eradication and prevention of BK nephropathy, along with IS reduction, particularly anti-proliferative immunosuppression reduction, without significant risk for the development of biopsy-proven rejection in pediatric kidney transplant recipients. Given the significant risk for the development of biopsy-proven rejection with complete AP discontinuation and CNI reduction in our study cohort, we suggest anti-proliferative reduction, not discontinuation, and judicious reduction in CNI trough goals with close monitoring as a strategy for treatment of BK viremia with concomitant use of leflunomide therapy.

Initiating Everolimus therapy early after pediatric HTX seems to be a safe and effective option for immunosuppression, with no incidence of cardiac allograft vasculopathy and a low incidence in chronic renal failure.