Pediatric Transplantation最新文献

{"title":"Sex-Based Differences in Rejection Among Pediatric Solid Organ Transplant Recipients.","authors":"Luke J Dotson, Ashley Montgomery, Josephine Schmidt, Nhu Thao N Galvan, John A Goss, Abbas A Rana","doi":"10.1111/petr.70071","DOIUrl":"10.1111/petr.70071","url":null,"abstract":"<p><strong>Background: </strong>Immunosuppression is paramount to prevent acute rejection in solid organ transplant but also poses a risk for infection and malignancy. Identifying factors that influence rejection may allow for personalization of treatment and avoidance of an unnecessary degree of immunosuppression for the vulnerable pediatric population.</p><p><strong>Methods: </strong>We conducted a retrospective review analyzing public data provided by the Organ Procurement and Transplantation Network for pediatric patients listed for solid organ transplantation (kidney, liver, lung, and heart) from March 1998 to December 2022. Univariate and multivariate logistic regression was used to identify independent risk factors for treated acute rejection at 6 months and/or 1 year for liver, lung, kidney, and heart transplants.</p><p><strong>Results: </strong>The study population consisted of the following pediatric patients for each organ studied: liver (n = 8993), lung (n = 846), heart (n = 7118), and kidney (n = 14 600). At 1 year, 28.4% and 31.7% of males and females, respectively, were treated for rejection in liver transplant, 24.1% and 34.5%, respectively, for lung, 14.8% and 16.2%, respectively, for kidney, and 25.2% for both in heart transplant. In multivariate analysis, male recipient status was a statistically significant protective factor against rejection in liver transplant, OR = 0.85 (p < 0.001), lung transplant, OR = 0.61 (p = 0.004), and kidney transplant, OR = 0.91 (p = 0.040), but not heart transplant, OR = 0.96 (p = 0.460).</p><p><strong>Conclusions: </strong>Our study demonstrates that pediatric males may have a lower risk of acute rejection in liver, lung, and kidney transplant yet not in heart transplant. These findings may have implications for the level of maintenance immunosuppression for pediatric male transplant recipients.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 3","pages":"e70071"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toxoplasmosis Prophylaxis Practices: A Survey of International Pediatric Solid Organ Transplantation Centers.","authors":"Benjamin R Hanisch, Monica I Ardura, Inci Yildirim, Mignon McCulloch, Marian G Michaels, Anita Verma","doi":"10.1111/petr.70058","DOIUrl":"10.1111/petr.70058","url":null,"abstract":"<p><strong>Background: </strong>Toxoplasma gondii can cause opportunistic infections leading to life-threatening disseminated disease after organ transplantation. However, there is a paucity of pediatric-specific data to guide recommendations for the prevention of toxoplasmosis after solid organ transplantation.</p><p><strong>Methods: </strong>To assess current practices, international pediatric transplant providers were surveyed.</p><p><strong>Results: </strong>Considerable variability in both screening and prophylaxis strategies was found across centers and organ types, with heart transplant programs performing more screening and prophylaxis. Trimethoprim/sulfamethoxazole was the preferred prophylaxis agent for each graft; no toxoplasmosis cases were recalled while patients received prophylaxis.</p><p><strong>Conclusion: </strong>More research is needed to clarify and standardize the optimal toxoplasmosis prevention strategy.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 3","pages":"e70058"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Activated Regulatory T Cells as a Biomarker of Chronic Allograft Inflammation in Pediatric Kidney Transplant Recipients.","authors":"Macyn L Leung, Ella Barrett-Chan, Megan K Levings, Suzanne Vercauteren, Tom D Blydt-Hansen","doi":"10.1111/petr.70041","DOIUrl":"10.1111/petr.70041","url":null,"abstract":"<p><strong>Background: </strong>There is a need for noninvasive immunological biomarkers that can identify stable kidney allograft immune quiescence to inform individualized immunosuppression.</p><p><strong>Methods: </strong>We conducted a cross-sectional, pilot cohort study evaluating the relative abundance of regulatory T cells (Tregs) to effector T-cell (Teff) populations as a surrogate marker of long-term graft tolerance. We obtained fresh peripheral blood mononuclear cell samples from stable pediatric kidney transplant recipients, most with recent surveillance biopsies to identify the presence or absence of chronic inflammation. Tregs were sub-phenotyped as naïve, memory, and activated Tregs (aTreg). Treg/Teff ratios were modeled for association with chronic inflammation and in the context of potential clinical features.</p><p><strong>Results: </strong>Twenty-seven patient samples were included on standard immunosuppression (tacrolimus, mycophenolate, and prednisone) with a mean age of 9.2 ± 5.0 years, at 30.2 ± 21.7 months posttransplant. The ratio of aTreg (FOXP3⁺⁺CD45RA^-) to Th17 cells (CD4⁺IL-17⁺) was significantly greater in patients without inflammation than in patients with graft inflammation (p < 0.01). Similarly, there was a trend toward greater aTreg/CD4⁺ T cells and aTreg/CD8⁺ Teff in patients without inflammation (p = 0.05 and 0.09, respectively). There was no significant association for inflammation with naïve or memory Treg/Teff ratios. Multiple logistic regression with all three aTreg/Teff ratios modeled allograft inflammation with high sensitivity and specificity (AUC = 0.83, 95% CI 0.67-0.98).</p><p><strong>Conclusions: </strong>The proportion of peripheral blood aTregs/Teff cells in this pilot cohort of stable pediatric kidney transplant recipients was associated with immune quiescence. These data support further investigation into aTreg/Teff monitoring to inform precision immunosuppressive treatment.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 2","pages":"e70041"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383159","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 the Patient: Implications of Addressing Health Literacy.","authors":"Dore-Stites Dawn","doi":"10.1111/petr.70053","DOIUrl":"10.1111/petr.70053","url":null,"abstract":"<p><p>Health literacy continues to demonstrate potential as a modifiable set of skills which can improve health care for individual patients. Recognizing and addressing limited health literacy been a commitment of the transplant community historically. This editorial outlines why the commitment remains important and how it can extend beyond our clinic walls.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 2","pages":"e70053"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic Root Dilatation in Children With End-Stage Kidney Disease on Regular Hemodialysis and After Kidney Transplantation.","authors":"Fatina I Fadel, Doaa M Salah, Hend A Elnaggar, Ahmed Abdel Wahed, Eman F Eryan","doi":"10.1111/petr.70039","DOIUrl":"10.1111/petr.70039","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) is the major cause of mortality in end-stage kidney disease (ESKD) patients. Aortic root dilatation (ARD) was recently recognized as a cardiovascular (CV) sequela in these patients. This study aims to evaluate the prevalence, risk factors, and progression of ARD in children with ESKD on regular hemodialysis (HD) and after kidney transplantation (KT).</p><p><strong>Methods: </strong>Seventy children in HD (HD group) and 80 pediatric kidney transplant recipients (KTR) (KT group) were included. The echocardiographic assessment was done twice at intervals of more than 6 months (6-14 months) except for 3 patients who died before the second assessment.</p><p><strong>Results: </strong>ARD's overall prevalence was higher in HD than in KT groups (71.4% and 40%). ARD was more prominent in patients with increased duration of ESKD, EDW, normalized IDWG%, and normalized UF vol%. In the KTR group, underweight was more prevalent among the ARD group than the non-ARD group. Patients with ARD had higher BP than patients without ARD. Most of the patients with ARD were on classic triple immunosuppressive therapy. ARD patients of both groups had lower HB, higher PLTS, Ph, Ca × Ph levels, and lower e-GFR than non-ARD patients.</p><p><strong>Conclusion: </strong>ARD is prevalent among ESKD children, with furthermore prevalence in HD than in KT patients. Younger age, lower BMI Z-scores, hypertension (HTN), and increased Ca × Ph are risk factors for ARD. Aortic root measures and ARD frequency decrease on ≥ 6-month follow-up of patients.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 2","pages":"e70039"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver Transplantation for Children With Budd-Chiari Syndrome: A Case Report From Vietnam and Literature Review.","authors":"Thanh Tri Tran, Thi Yen Nhi Truong, Hong Van Khanh Nguyen, Nguyen An Thuan Luu, Trong Thien Than, Hai Trung Bui, Phi Duy Ho, Thierry Pirotte, Raymond Reding","doi":"10.1111/petr.70038","DOIUrl":"10.1111/petr.70038","url":null,"abstract":"<p><p>Budd-Chiari syndrome (BCS) presents with various degrees of liver damage, and the choice of treatment depends on the type and extent of hepatic injury. Liver transplantation (LT) is considered as the final treatment option when other interventions are not feasible and when the liver injury is irreversible. We report a case of a pediatric patient with BCS who underwent liver transplantation from a living donor in the context of thrombophilic disorder.</p><p><strong>Case presentation: </strong>A 14-month-old girl was admitted to the hospital with ascites. She was malnourished, and an abdominal CT scan confirmed significant ascites with no visualization of the hepatic veins and retrohepatic inferior vena cava (IVC). A liver biopsy revealed fibrosis, necrosis, and parenchymal hemorrhage. Patient's portal hypertension was managed with prophylactic beta-blocker Propranolol and endoscopic esophageal variceal ligation. However, she was hospitalized four times due to gastrointestinal bleeding from ruptured esophageal varices. Protein C deficiency was found as probable etiology of BCS. The patient underwent liver transplantation at 3 years and 8 months old with a liver from a parental living donor. The surgery and postoperative course were uneventful, and the patient was discharged 25 days after the transplant.</p><p><strong>Clinical discussion: </strong>Hypercoagulability is often the underlying cause of BCS. Maintaining anticoagulation/thrombophilic balance postoperatively contributed to the successful liver transplantation in this pediatric patient.</p><p><strong>Conclusion: </strong>Liver transplantation is a safe and effective treatment for pediatric patients with BCS who meet the criteria for the procedure.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 2","pages":"e70038"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-Transplant Immunophenotyping in Pediatric Heart Transplant: A Role for the Immunologist?","authors":"Lauren Gunderman, Nicola Lancki, Brian Madden, Aisha Ahmed","doi":"10.1111/petr.70052","DOIUrl":"10.1111/petr.70052","url":null,"abstract":"<p><strong>Background: </strong>Pediatric heart transplant recipients are at risk for complications from prolonged exposure to immunosuppressive drugs, possibly worsened due to over-immune suppression in patients with pre-existing immune abnormalities.</p><p><strong>Methods: </strong>This was a retrospective, single-center pediatric cohort study and review of baseline immune evaluation in patients referred for heart transplant. Referrals included were from January 1, 2021, to June 31, 2022.</p><p><strong>Results: </strong>Fifty-one patients were referred during the time period with a median age of 5 years (ranging 1 month-20 years). Twenty-seven total patients were transplanted. Given a lack of standardized immune evaluation, results were focused on lymphocyte quantitation, functional testing when available, and T-cell subsets. Outcome measures focused on the number of infections and episodes of rejection requiring treatment. In total, 44.4% of patients experienced rejection, and the mean number of infections in the first 12 months post-heart transplant was 2.1 (range 0-7 total infections).</p><p><strong>Conclusions: </strong>Baseline immune evaluation showed general T and B cell lymphopenia, without a clear connection between outcome differences for the number of infections or episodes of rejection requiring treatment. This small study demonstrated some differences in immune function in patients prior to heart transplant but was inadequately powered to draw conclusions about the effects of immunosuppression on post-transplant outcomes.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 2","pages":"e70052"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483903","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":"Incidence and Management of Posttransplantation Lymphoproliferative Disorder After Pediatric Solid Organ Transplantation: The Norwegian Experience.","authors":"Olav Sondre Skorge Aartun, Karen Henriette Hustveit, Monica Cheng Munthe-Kaas, Ann Christin Gjerstad, Anna Bjerre, Anniken Bjørnstad Østensen, Thomas Möller","doi":"10.1111/petr.70040","DOIUrl":"10.1111/petr.70040","url":null,"abstract":"<p><strong>Background: </strong>Posttransplant lymphoproliferative disorder (PTLD) is a complication of solid organ transplantation (SOT) due to immunosuppression. In 2023, a pediatric PTLD register was established in Norway because of a perceived increase in the incidence of pediatric PTLD. This study aimed to analyze population-based data on the incidence and management of pediatric PTLD after SOT using the pediatric PTLD registry in Norway.</p><p><strong>Methods: </strong>This retrospective quality assurance study collected the data of pediatric patients with PTLD after SOT in Norway from January 1, 1995, to December 31, 2023. For comparison and calculation of incidence rates, SOT patients without PTLD required a minimum of 1 year posttransplant follow-up to be included.</p><p><strong>Results: </strong>A total of 457 patients underwent SOT (57% males) and 22 (4.8%) developed PTLD (73% males). The median age at transplant in the SOT and PTLD groups were 9.5 (interquartile range, 2.4-14.5) and 4.3 (1.1-12.5) years, respectively. Twenty patients with PTLD (91%) were Epstein-Barr virus naive at the time of transplantation. Eighteen (82%) and four (18%) patients developed early and late PTLD, respectively. Ten patients had monomorphic PTLD (45%). All patients received a reduction in immunosuppression, 15 received rituximab, and six required chemotherapy. Six patients (27%) died after PTLD, five of whom had active PTLD disease at the time of death. None of the patients experienced graft loss.</p><p><strong>Conclusions: </strong>Our findings regarding the incidence, EBV status, sex, and age at transplantation align with those of previous studies.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 2","pages":"e70040"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Survival in Children Following Heart Transplantation.","authors":"Emily A Hayes, Devin Koehl, Ryan Cantor, Lauren A Fisher, Estela Azeka, Deepa Mokshagundam, Alfred Asante-Korang, Paolo Rusconi, Matthew J O'Connor, Deipanjan Nandi, James K Kirklin, Gerard J Boyle","doi":"10.1111/petr.70042","DOIUrl":"10.1111/petr.70042","url":null,"abstract":"<p><strong>Background: </strong>Short-term outcomes following heart transplantation in children have improved, but comparable improvements in long-term survival continues to have barriers. We sought to investigate long-term outcomes following heart transplantation and to identify protective and risk factors associated with long-term survival in children.</p><p><strong>Methods: </strong>The Pediatric Heart Transplant Society (PHTS) database was queried for heart transplant recipients from 1993 to 2010 who were ≤ 10 years of age at time of transplant. Patients with conditional graft survival > 3 years and at ≥ 10 years were analyzed. Survival and time-to-event were compared using the Kaplan-Meier method with a log-rank test for significance. Factors associated with graft loss were identified using Cox proportional hazard modeling.</p><p><strong>Results: </strong>There were 1610 patients ≤ 10 year of age who were transplanted between 1993 and 2010 with conditional survival to 3 years post-transplant. Of those patients, there were 1170 with conditional survival to 10 years post-transplant. Patients < 1 year at transplant had improved survival compared to other age groups. Risk factors for graft loss after 3 years post-transplant were malignancy, rejection, cardiac allograft vasculopathy (CAV), age, congenital heart disease, female sex, and Black race (p value for all < 0.05).</p><p><strong>Conclusions: </strong>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. Further studies are needed to understand the social and biologic causes of racial and sex disparities in pediatric transplant patients.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 2","pages":"e70042"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Liver Transplantation-Burkitt Lymphoma in Children: A Single-Center Study of Clinical Characteristics, Treatment, and Outcomes.","authors":"Tianran Chen, Weiping Zheng, Ruofan Wang, Chong Dong, Chao Sun, Kai Wang, Chao Han, Xinzhe Wei, Wei Gao","doi":"10.1111/petr.70027","DOIUrl":"10.1111/petr.70027","url":null,"abstract":"<p><strong>Background: </strong>Post-liver transplantation-Burkitt lymphoma (PLT-BL) is an aggressive and life-threatening complication after pediatric liver transplantation. The research on the disease characteristics, treatment, and prognosis of pediatric PLT-BL is limited.</p><p><strong>Methods: </strong>A retrospective, observational study was performed to analyze the disease characteristics, treatment, and outcomes in 12 pediatric liver transplant (LT) recipients diagnosed with PLT-BL.</p><p><strong>Results: </strong>The medium time from liver transplantation to diagnosis was 32.71 months (range, 25.78-37.85 months). All patients (100%) tested positive for EBV viremia at diagnosis. Abdomen and peripheral lymph nodes were the most frequently involved sites (11 [91.66%] and 10 [83.33%], respectively). Three pediatric patients were diagnosed as relapsed or refractory PLT-BL and treated with chimeric antigen receptor (CAR) T-cell therapy, and two of them achieved complete remission (CR). Nine patients were alive with CR at the last follow-up. Three deaths were attributed to progression and tumor lysis syndrome, characterized by significantly elevated lactate dehydrogenase (LDH) levels (p = 0.027), more advanced tumor stages (p = 0.045), and an increased number of involved sites (p = 0.009). With a median follow-up of 2.7 years after diagnosis, the event-free survival (EFS) and overall survival (OS) rates for PLT-BL patients were 66.7% and 74.1%, respectively. In four patients, immunosuppression was successfully withdrawn and they maintained tolerance status.</p><p><strong>Conclusion: </strong>Elevated LDH levels, more advanced tumor stages, and increased number of involved sites are potentially associated with poor outcome. Immunosuppression withdrawal is a safe and feasible approach for PLT-BL.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 2","pages":"e70027"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}