Pediatric Transplantation

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.

We analyzed a retrospective, observational cohort of 51 patients with pediatric acute liver failure with severe hepatic encephalopathy (grade III-IV), admitted between 1993 and 2023. The survival rate in patients with present PR was higher compared to patients with absent PR (70% and 29%, respectively). In the absence of PR, the neurological outcome could still be favorable after liver transplantation (LTx) (n = 3/6). Radiologically proven brain herniation was associated with mortality (6/7) or minimally conscious state (1/7), irrespective of undergoing a LTx or not.

Our single-institution 15-year experience with simultaneous bilateral native nephrectomy (BNN) in pediatric patients demonstrates utility and safety. We discuss considerations of BNN relative to timing of transplantation, an area of conversation. We demonstrate that a minimally invasive approach is feasible, and the surgical approach should consider the route of current or planned dialysis.

Sibling (ages 12–17 years) of kidney and liver transplant recipients affirm that the transplant event is distressing and impacts their relationships and family functioning both in the moment and for years after the transplant. Transplant team members can support siblings through healthcare interactions and a family-inclusive model of care.

Reduced mycophenolate mofetil with a sufficient trough tacrolimus level in a population of mainly corticosteroid-free pediatric kidney transplant recipients did not lead to unacceptable alloimmunity.

The low incidence of cardiovascular changes in the population studied confirms the benefit of transplantation for the cardiovascular health of children. Only 4% of sample had an LV mass Z-score ≥ 2.0. After multivariate analysis, only gender, serum triglyceride, and serum renalase concentration remained significantly associated with LV mass.

The results support the policy of avoiding HLA combinations that preclude immune recognition of graft lymphocytes as foreign to decrease the risk of GVHD after living donor liver transplantation.

In this single-center study of 177 pediatric heart transplant recipients, 7% developed acute kidney injury requiring dialysis (AKI-D), with increased cardiopulmonary bypass time and higher weight at transplant associated with higher odds of AKI-D. AKI-D was associated with greater mortality during initial hospitalization and lower kidney failure-free survival.

Family cohesion and social support from people in school are important in post-transplant health-related quality of life (HRQOL). Relative to comparable samples, transplant recipients reported more optimal family environment, greater teacher social support, and lower social support from close friends. Psychosocial interventions for adolescents should incorporate school supports and family strengths.

The Pedi-ITT index includes 12 factors found to be significant in predicting intent-to-treat survival for pediatric liver transplant recipients. Our index has a moderate predictive value with a c-statistic of 0.79 as compared to the MELD/PELD and Pedi-SOFT score indices, which had c-statistics of 0.74 and 0.69, respectively.

We followed 10 patient with chronic pancreatitis who underwent TPIAT and were followed at our multidisciplinary pancreas center.

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.

A cystatin-C-based estimated GFR provides a viable substitute for monitoring renal function in pediatric patients with chronic kidney disease. However, it has a lower accuracy than measured GFR and can therefore not replace measured GFR in clinical use.