Pediatric Transplantation最新文献

{"title":"Beyond the Transplant: Chronic Kidney Disease in Pediatric Hematopoietic Stem Cell Transplant Survivors-A 20-Year Single-Center Cohort Study.","authors":"Alcotzer Inbar, Talgam-Horshi Efrat, Sidlik Muskatel Rakefet, Kraus Aviva, Yanir Assaf, Yahel Anat, Stein Jerry, Levy-Erez Daniella","doi":"10.1111/petr.70417","DOIUrl":"10.1111/petr.70417","url":null,"abstract":"<p><strong>Background: </strong>Pediatric hematopoietic stem cell transplantation (HSCT) is curative for malignant and non-malignant diseases, yet survivors remain at substantial risk for late renal complications. Data on chronic kidney disease (CKD) incidence and its determinants in pediatric HSCT recipients are limited.</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study of 261 pediatric patients (aged 0-21 years) who underwent HSCT at Schneider Children's Medical Center, Israel, between 2000 and 2020. Acute kidney injury (AKI) was defined per KDIGO creatinine criteria. CKD was defined as eGFR < 90 mL/min/1.73 m² sustained ≥ 3 months and/or proteinuria or hypertension. Given the limited number of CKD events, multivariable logistic regression identifying factors associated with CKD was treated as exploratory. Overall survival was analyzed using Kaplan-Meier methodology.</p><p><strong>Results: </strong>AKI episodes occurred in 20.5% of patients during the first three months post-HSCT. CKD incidence increased progressively: 6.0% at one year, 8.6% at three years, and 16.5% at five years-substantially exceeding the ~5% background prevalence reported in the general Israeli pediatric population. Older age at transplantation was the only variable significantly associated with CKD in this exploratory model (mean 11.96 vs. 7.12 years in the CKD and non-CKD groups, respectively; p = 0.008). A higher proportion of patients who developed CKD had undergone four or more transplantations compared with those who did not (31.6% vs. 3.7%), though this difference did not reach statistical significance (p = 0.22) and should be regarded as hypothesis-generating. Patients with a borderline baseline creatinine in the early post-transplant period had lower overall survival than those with a normal baseline creatinine (log-rank p = 0.05), an association whose biological basis requires further study.</p><p><strong>Conclusions: </strong>CKD affects a substantial and growing proportion of pediatric HSCT survivors in this cohort, particularly those transplanted at older ages. These findings are associative rather than causal, given the retrospective, single-center design and limited number of CKD events. They nonetheless support systematic long-term renal surveillance and nephrology referral as part of post-HSCT survivorship care, with prospective, adequately powered studies needed to confirm risk factors and clarify mechanisms.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70417"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13463283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aligning Words With What Matters: Evaluation of a Nationwide Sample of Pediatric Kidney Transplant Educational Materials.","authors":"Taylor R House, Makayla A Thomas, Aaron Wightman, Kelly Helm, Ryan J Coller, Ari Pollack, Susan P Y Wong","doi":"10.1111/petr.70421","DOIUrl":"10.1111/petr.70421","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplant education promotes early partnership between children, caregivers, and clinicians by sharing information and fostering engagement to maximize outcomes. We evaluated educational materials' accessibility, alignment with shared priorities, and portrayal of life participation.</p><p><strong>Methods: </strong>We performed a content analysis of pediatric kidney transplant centers' educational materials to assess how they addressed 4 key priorities: kidney function, infection, survival, and life participation. We assessed printed materials' readability using Simple Measures of Gobbledygook and Flesch-Kincaid tools and audiovisual materials' understandability and actionability using the Patient Education Materials Assessment Tool.</p><p><strong>Results: </strong>Of 73 centers approached, 23 (32% response) provided educational packets. Only 6 packets (26%) included materials targeted to children. Average reading grade level was high (SMOG 8.9 ± 1.7; Flesch-Kincaid 9.5 ± 1.8), with only 1 packet written at sixth-grade level. Audiovisual materials were not highly understandable or actionable. Among key priorities shared by children, caregivers, and clinicians, packets most frequently addressed infection, followed by kidney function, life participation, and survival. We identified 3 themes reflecting portrayal of the key priority of life participation: hope and caution-a proactive, optimistic tone about certain aspects of life participation and cautious tempering of expectations for others; maximizing physical transplant benefits-detailed guidance on physical activity, but limited attention to psychosocial well-being; and being \"normal\"-a focus on restoring physical health while framing mental and emotional distress as potential threats to normalcy.</p><p><strong>Conclusions: </strong>There are important opportunities to enhance transplant educational materials by tailoring content to children, increasing accessibility, and more consistently and comprehensively addressing concerns about life participation after transplant.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70421"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13430431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing, Phenotype, and Reversibility of Neurological Complications After Pediatric Liver Transplantation.","authors":"Teruhiko Imamura","doi":"10.1111/petr.70437","DOIUrl":"https://doi.org/10.1111/petr.70437","url":null,"abstract":"","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70437"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13482296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influenza Disease Burden and Vaccine Effectiveness in Children and Adolescents With Solid Organ Transplant: 2018-2024.","authors":"Daniela Barisano, Justin K Chen, Hillary Kuzaro, Anastacia Serluco, Mark D Gonzalez, Gwen Nance, Keyner Rojas, Precious Nchekwube, Elizabeth Cohen, Inci Yildirim","doi":"10.1111/petr.70433","DOIUrl":"10.1111/petr.70433","url":null,"abstract":"<p><strong>Background: </strong>Solid organ transplant (SOT) recipients have an increased risk of influenza infection. Annual vaccination is the primary strategy to reduce the burden of influenza disease, but vaccine effectiveness (VE) varies annually for influenza. There is limited data published demonstrating influenza VE in pediatric SOT over time.</p><p><strong>Methods: </strong>We conducted a retrospective, case-control study using a test-negative design to estimate influenza VE against laboratory-confirmed influenza infections among pediatric SOT recipients aged 6 months to 21 years at two large pediatric transplant centers, spanning the six influenza seasons from fall 2018 through spring 2024. Logistic regression models were used to compare odds ratios (ORs) of vaccination in cases to controls. VE was calculated as [100% × (1 - adjusted OR)], and 95% confidence intervals (CIs) were computed around the estimates.</p><p><strong>Results: </strong>Across all 6 seasons, there were 4 585 patient encounters, of which 961 had an influenza test and were included in the study. Overall, 750 (78.0%) patients received the seasonal influenza vaccine, and 94 (9.9%) tested positive for influenza. Among vaccinated patients, the prevalence of influenza diagnosis was lower (6.8%) than among unvaccinated patients (20.4%) (OR 0.28, 95% CI 0.18-0.43). The adjusted VE against laboratory-confirmed influenza infection was 72.0% (95% CI 57.0-82.0) and varied by season. VE was similar between organ groups: Kidney (65.9%, 95% CI 29.7-83.4), heart (86.4%, 95% CI 59.0-95.5), and liver (71.7%, 95% CI 41.6-86.3).</p><p><strong>Conclusions: </strong>Influenza vaccination decreased the risk of influenza infection among pediatric SOT recipients for the 2018-2024 influenza seasons.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70433"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defending Principled Advocacy for Children in Modern Organ Transplant.","authors":"Syed Ali Husain, Nadia Ovchinsky, Matthew Goldstein, Macey L Levan","doi":"10.1111/petr.70442","DOIUrl":"10.1111/petr.70442","url":null,"abstract":"","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70442"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EXPRESSION OF CONCERN: Tacrolimus-Related Seizure After Pediatric Liver Transplantation - A Single-Center Experience.","authors":"","doi":"10.1111/petr.70344","DOIUrl":"10.1111/petr.70344","url":null,"abstract":"","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 7","pages":"e70344"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148397303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Survival: Additional Considerations for Sequential HeartMate 3 Support and Heart Transplantation in Adolescents With Dilated Cardiomyopathy.","authors":"Teruhiko Imamura","doi":"10.1111/petr.70404","DOIUrl":"10.1111/petr.70404","url":null,"abstract":"","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 7","pages":"e70404"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13354960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Ambulatory Blood Pressure Monitoring in Pediatric Heart Transplant Recipients.","authors":"Bushra Anjum, Shannon Oliver, Amira Balbaa, Rae Foshaug, Jennifer Conway, Simon Urschel, Lori J West, Michael Khoury","doi":"10.1111/petr.70386","DOIUrl":"10.1111/petr.70386","url":null,"abstract":"<p><strong>Background: </strong>Ambulatory blood pressure monitoring (ABPM) is the gold-standard non-invasive test for diagnosing arterial hypertension; however, it remains understudied in pediatric heart transplant recipients (HTRs). We evaluated the role of ABPM in diagnosing and managing hypertension.</p><p><strong>Methods: </strong>We conducted a single-center retrospective evaluation of pediatric HTRs transplanted between 2010 and 2023 (inclusive) with ≥ 1 post-transplant ABPM. Clinic blood pressures (CBPs) temporally linked to each ABPM were used to categorize patients into blood pressure phenotypes: normotensive (including well-controlled hypertension, if on anti-hypertensive therapy), sustained, white coat (WCH), and masked hypertension (MH). Demographic, clinical, and echocardiographic characteristics were compared across hypertensive phenotypes, with longitudinal changes evaluated using serial ABPMs.</p><p><strong>Results: </strong>Data were available for 33 pediatric HTRs (61% female [20/33], median age at first ABPM 7.3 [5.3-10.4] years, 0.7 [0.2-2.6] years post-transplant). At the initial ABPM, 82% (27/33) were normotensive and 18% (6/33) were hypertensive, with 79% (26/33) on ≥ 1 antihypertensive medication. Of those with hypertensive CBPs, 60% (6/10) had a normal ABPM indicating WCH. At subsequent ABPM, 48% (10/21) normotensive patients remained normotensive, while 43% (9/21) developed hypertension. Among the 6 patients with WCH, 5 (83%) developed subsequent hypertension by ABPM. Median left ventricular mass was higher in hypertensive patients (160.9 g, 64.3-172.3 g) compared with WCH (54.4 g, 36.9-100.7 g) and normotensive patients (66.9 g, 45.4-94.3 g) (p = 0.032).</p><p><strong>Conclusions: </strong>ABPM provides important hypertension insights for pediatric HTRs, especially with abnormal CBPs. Progression from WCH to manifest hypertension was common. ABPM should therefore be utilized prior to implementing or modifying anti-hypertensive therapy.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 7","pages":"e70386"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13312147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dupilumab Is Safe and Efficacious for Treatment of Eosinophilic Esophagitis and Atopic Dermatitis in Pediatric Liver Transplant Recipients: A Case Series.","authors":"Christina Yuen, Laura J Wozniak, Ronald Cotliar, Robert S Venick","doi":"10.1111/petr.70382","DOIUrl":"10.1111/petr.70382","url":null,"abstract":"<p><strong>Background: </strong>Transplant-acquired atopy and allergic disorders, including atopic dermatitis and eosinophilic gastrointestinal disorders, are known complications of organ transplantation. They have been noted to be more prevalent following liver transplantation than other solid organ transplantations. The pathophysiology is unknown; however, tacrolimus immunosuppression has been hypothesized to play a role via T helper 2 cell predominance, leading to increased interleukin-4 and interleukin-13 expression. Dupilumab, a monoclonal antibody that downregulates interleukin-4, interleukin-13, and the T helper 2 cell pathway, is effective for atopic dermatitis and eosinophilic esophagitis, though there is a paucity of data regarding its use and safety in pediatric liver transplant recipients.</p><p><strong>Methods and results: </strong>We report a series of cases of pediatric liver transplant recipients from a single center who developed severe atopic dermatitis or eosinophilic esophagitis that was refractory to routine treatments and immunosuppression changes. These atopic conditions also severely affected their quality of life. After initiation of dupilumab, the patients had improvement in both their atopic conditions and quality of life. Patients who did not have evidence of graft dysfunction or rejection prior to initiation of dupilumab maintained normal biochemical graft function. Patients who had rejection prior to starting dupilumab did not develop acute worsening of their graft function or rejection.</p><p><strong>Conclusions: </strong>In this case series, dupilumab was seen to be effective for pediatric liver transplant recipients who developed atopic dermatitis or eosinophilic esophagitis that was refractory to routine treatment and immunosuppression changes. While receiving dupilumab, these patients did not develop worsening graft function or rejection.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 7","pages":"e70382"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148332126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aeromonas Bacteremia in Pediatric Liver Transplant Recipients: Case-Based Experience of an Under-Recognized Infection.","authors":"Toshihiro Matsui, Masaki Yamada, Kensuke Shoji, Takanori Funaki, Miyuki Jinguji, Hajime Uchida, Akinari Fukuda, Seisuke Sakamoto, Mureo Kasahara, Chikara Ogimi","doi":"10.1111/petr.70407","DOIUrl":"10.1111/petr.70407","url":null,"abstract":"<p><strong>Background: </strong>Aeromonas species can cause bacteremia, but their epidemiology and clinical significance in pediatric liver transplant (LT) recipients are unclear. We evaluated the incidence, clinical features, management, and outcomes of Aeromonas bacteremia in this population.</p><p><strong>Methods: </strong>We performed a retrospective observational study at a tertiary pediatric LT center from November 2005 to April 2023. Patients who underwent LT before 18 years of age were reviewed, and cases of Aeromonas bacteremia were analyzed in detail.</p><p><strong>Results: </strong>Among 746 children who underwent LT, five episodes of Aeromonas bacteremia were identified. The incidence was 0.82 cases per 1000 person-years. Median age at LT was 2 years, and median interval from LT to bacteremia was 6 years (range, 2 months-24 years). All patients were receiving maintenance immunosuppression without neutropenia or significant liver dysfunction, and none were receiving antibiotics, including trimethoprim-sulfamethoxazole prophylaxis at the time of Aeromonas bacteremia. No patient had recent hepatobiliary procedures or biliary obstruction. All presented with fever; three had fever without source, and three reported freshwater exposure. Blood cultures yielded A. hydrophila/caviae (n = 3) or A. sobria (currently A. veronii biovar sobria) (n = 2). All isolates were susceptible to the empiric antibiotic regimens. Definitive therapy consisted of cefotaxime or cefepime, with or without metronidazole. All patients survived without progression to life-threatening sepsis or relapse.</p><p><strong>Conclusions: </strong>In pediatric LT recipients, Aeromonas bacteremia can occur late after transplantation under mild immunosuppression and without recognizable biliary risk factors. Early recognition and appropriate antibiotic therapy may contribute to favorable outcomes.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 7","pages":"e70407"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13370038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148448671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}