Pediatric Transplantation最新文献

{"title":"Trends in Specific Family Refusals for Pediatric Organ and Tissue Donation: A Cross-Sectional Study.","authors":"Danton Matheus de Souza, Niflyer Costa Miranda, Rafael Rodrigo da Silva Pimentel, Edvaldo Leal de Moraes, Marcelo José Dos Santos","doi":"10.1111/petr.70028","DOIUrl":"10.1111/petr.70028","url":null,"abstract":"<p><strong>Background: </strong>When a family decides to donate the organs or tissues of their child with brain death, it is necessary to consider which organs or tissues will be donated. This phenomenon presents an ethical dilemma that is underexplored in the scientific literature, making it essential to examine this context to understand how refusals occur within donations.</p><p><strong>Objective: </strong>To analyze the rates and trends of specific refusals for each organ and tissue from pediatric donors with brain death occurring between 2001 and 2020 in an Organ Procurement Organization in the State of São Paulo, Brazil.</p><p><strong>Methods: </strong>This was a cross-sectional, exploratory, retrospective, quantitative study. Data were derived from a database consisting of copies of organ and tissue donation authorization forms, organized, and subjected to descriptive and inferential analyses. This study adhered to international ethical guidelines.</p><p><strong>Results: </strong>Data from 109 real donors were analyzed. The bones, skin, and blood vessels had the highest refusal rates among tissues, as well as the pancreas and lungs for solid organs. Most organs and tissues showed a decreasing refusal trend except for the corneas, liver, and kidneys, which exhibited a stationary trend.</p><p><strong>Conclusions: </strong>This study illustrates the refusals within real donations, with high refusal rates for tissues compared to solid organs.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 1","pages":"e70028"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009908","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":"Chronic Kidney Disease-Mineral Bone Disorder (CKD-MBD) in Pediatric Kidney Transplant Recipients.","authors":"Zenab Tamer, Mark R Hanudel, Isidro B Salusky","doi":"10.1111/petr.70021","DOIUrl":"10.1111/petr.70021","url":null,"abstract":"<p><p>Kidney transplantation remains the gold standard treatment for end-stage kidney disease (ESKD), effectively alleviating numerous comorbidities and offering a substantial survival advantage over long-term dialysis. Despite advancements in immunosuppressive regimens and improvements in graft and patient survival rates, extended patient longevity brings an accumulating burden and complexity of bone disease in this population, which often goes underrecognized. The present study reviews the pathophysiology of CKD-MBD in pediatric KTR, focusing on the progression of bone disease before and after transplantation. We aim to enhance understanding of available screening options, highlighting their advantages and limitations, to support more informed decision-making in CKD-MBD management.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 1","pages":"e70021"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009761","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":"Tracheostomy as a Management Option After Listing for Pediatric Cardiac Transplantation.","authors":"Elisabeth Day, Deborah Cross, David Crossland, Jason Powell, Emma Simpson","doi":"10.1111/petr.70029","DOIUrl":"10.1111/petr.70029","url":null,"abstract":"<p><strong>Background: </strong>Children with end-stage heart failure listed for cardiac transplantation may require mechanical ventilation and/or circulatory support whilst awaiting transplantation. A subgroup of these patients is unable to wean off mechanical ventilator support and undergo tracheostomy to enhance quality of life and allow de-escalation of intensive care. There is limited evidence of the use of tracheostomy associated with pediatric cardiac transplantation. We describe outcomes to better inform future management of these patients.</p><p><strong>Methods: </strong>A single-centre, retrospective study was performed, assessing all pediatric patients (< 18 years) listed for cardiac transplant from 2006 to 2017. We assessed background demographics and outcomes, including cardiac diagnosis, complications, insertion of ventricular assist device and survival. We identified patients who underwent tracheostomy after listing and compared this group with non-tracheostomised patients.</p><p><strong>Results: </strong>Two hundred and eleven patients were listed for cardiac transplant, of whom 44 (21%) underwent tracheostomy after listing. The main indication for tracheostomy was failure to wean from mechanical ventilation (36%). Complications after tracheostomy included localized infection, granuloma, obstruction and hemorrhage, but were generally minor. Median time for tracheostomy decannulation was 75 days. When comparing tracheostomy versus non-tracheostomy patients, there were no significant differences in age, weight or time to transplant. Survival was comparable between the non-tracheostomy and tracheostomy groups at 1-year, 97% versus 94% respectively.</p><p><strong>Conclusion: </strong>There is no evidence from our study that patients awaiting cardiac transplant who undergo tracheostomy have significant complications or reduced survival. Tracheostomy is usually a short-term measure and should be considered in the management of children receiving prolonged ventilation around the time of cardiac transplantation.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 1","pages":"e70029"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11750632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009802","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":"CMV Reactivation Following Allogeneic Transplantation in Children From a High-Seroprevalence Population: A Single-Center Experience in Colombia.","authors":"Andres Arias, Natalia Builes, Laura Niño-Serna, Alejandro Diaz, Beatriz H Aristizabal, Monica Trujillo","doi":"10.1111/petr.70033","DOIUrl":"10.1111/petr.70033","url":null,"abstract":"<p><strong>Introduction: </strong>Cytomegalovirus (CMV) infection is a frequent complication among hematopoietic stem cell transplant (HSCT) recipients. Data regarding CMV reactivation in children in underdeveloped countries is scarce. This is especially notable considering the increasing utilization of haploidentical-related HSCT with the post-transplant cyclophosphamide platform. This study aimed to describe the incidence, clinical characteristics, and evolution of children with CMV reactivation after HSCT and the possible impact of unmanipulated stem cells with PTCy for GvHD prophylaxis.</p><p><strong>Methods: </strong>Retrospective cohort study of children undergoing hematopoietic stem cell transplantation from January 2012 to June 2022. Baseline characteristics and the clinical course were described. Duration of treatment, initial viral load, and time to clearance of DNAemia by type of transplant were compared using the Kruskal-Wallis test. Survival analysis was performed with the Kaplan-Meier method and log-rank test. All statistical analysis was performed using SPSS software, version 20.0.</p><p><strong>Results: </strong>One hundred sixty-six children were included. Among them, 87% of recipients and 88% of donors were CMV positive. The cumulative incidence of cytomegalovirus DNAemia was 28% at 100 days post-transplantation. There were no differences between different donor types. Overall survival at 1 year was 60%, and non-relapse mortality was observed in 28%. CMV reactivation did not appear to negatively impact 1-year overall survival (OS).</p><p><strong>Conclusions: </strong>Our study found no differences in CMV reactivation rates, treatment duration, viral clearance times, co-infections, or 1-year overall survival across different HSCT donor types. Studies are needed to establish more precise criteria for monitoring recipients, particularly in regions where unmanipulated stem cells with PTCy for GvHD prophylaxis are increasing.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 1","pages":"e70033"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009770","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":"Risk Factors of Hypothermia During Pediatric Liver Transplantation Using a Novel Warming Method.","authors":"Taiga Ishihara, Chiaki Baba, Kaoru Ishizaki, Jun Ninagawa, Shugo Kasuya","doi":"10.1111/petr.14902","DOIUrl":"10.1111/petr.14902","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative hypothermia often occurs in patients under general anesthesia, including liver transplantation (LT), leading to various life-threatening conditions. This study aimed to evaluate factors causing hypothermia in patients undergoing pediatric LT.</p><p><strong>Methods: </strong>Data were collected from patients undergoing LT who were warmed during surgery. The participants were divided into the hypothermia group, comprising patients with intraoperative hypothermia (< 35°C), and the normothermia group, comprising patients without hypothermia (≧ 35°C). These two groups were compared in terms of preoperative conditions (weight, height, Body mass index, age [months], and pediatric end-stage liver disease score), intraoperative findings (surgical duration, graft-to-recipient weight ratio, cold ischemic time, warm ischemic time, length of the an-hepatic period, volume of blood loss, and volume of blood transfusion), and postoperative findings (complications within 30 days, rejection within 30 days, and length of intensive care unit and hospital admission).</p><p><strong>Results: </strong>The hypothermia and normothermia groups differed in terms of age, weight, height, pediatric end-stage liver disease score, graft-to-recipient weight ratio, volume of blood loss, volume of blood transfusion (red cell concentrate and fresh frozen plasma), the duration of intensive care unit admission, and rejection within 30 days (all p < 0.05). After multivariate analysis, only the number of patients experiencing rejection was associated with intraoperative hypothermia (odds ratio = 32.553, 95%CI: 2.198-482.226, p = 0.011).</p><p><strong>Conclusions: </strong>Rejection was particularly related to intraoperative hypothermia.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 1","pages":"e14902"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801993","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":"Transcatheter Pulmonary Flow Restrictors as a Palliative Bridge to Heart Transplant.","authors":"Mats Steffi Jennifer Masilamani, Jonathan N Johnson, Rebecca K Ameduri, Elizabeth H Stephens, Allison K Cabalka, Jason H Anderson","doi":"10.1111/petr.70025","DOIUrl":"10.1111/petr.70025","url":null,"abstract":"<p><strong>Background: </strong>In recent years, transcatheter implantation devices to restrict pulmonary arterial flow have emerged as a potential alternative to surgical pulmonary artery banding.</p><p><strong>Case presentation: </strong>A term male was diagnosed with critical aortic stenosis (AS) and severely reduced left ventricle (LV) systolic function. He underwent aortic balloon valvuloplasty on day 2 of life, resulting in some antegrade flow, but LV ejection fraction only improved to 15%. He remained ductal dependent for systemic perfusion. Pulmonary over-circulation ensued with systemic steal evident in his second week of life. On day 14, he underwent a transcatheter stage 1 procedure including the placement of bilateral pulmonary flow restrictor (PFR) devices and ductal stenting. Post-procedure, he improved clinically, weaned off respiratory support, and transitioned to oral feeds while awaiting cardiac transplant. Twelve days later, he received a donor heart, with an uneventful recovery. He is now 3 years post-transplant and has excellent graft function, and his transplant course has been unremarkable.</p><p><strong>Conclusion: </strong>Transcatheter-based palliation for a neonate with critical AS, utilizing endoluminal PFRs, proved effective in stabilizing the infant and successfully bridging him to transplant. This highlights an opportunity for the utilization of PFRs in neonatal conditions where control of pulmonary blood flow is imperative as a bridge to transplantation.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 1","pages":"e70025"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009808","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":"Impact of Hepatoblastoma on Infectious Complications Following Pediatric Liver Transplantation.","authors":"Ashton D Hall, Hope A Hendricks, Katherine A Bowers, James I Geller, Alexander J Bondoc, Greg M Tiao, Amy E Taylor, William R Otto, Grant C Paulsen, Lara A Danziger-Isakov","doi":"10.1111/petr.70035","DOIUrl":"10.1111/petr.70035","url":null,"abstract":"<p><strong>Background: </strong>Liver transplantation is the standard therapy for end-stage liver disease in pediatric patients with biliary atresia (BA), congenital and metabolic conditions, and for an unresectable malignant tumor like hepatoblastoma (HB). BA is the leading indication for pediatric liver transplantation, while HB is the most common childhood liver cancer. Despite improved outcomes through advanced surgical techniques and novel immunosuppression, pediatric liver transplantation (pLT) is complicated by post-transplant infections.</p><p><strong>Methods: </strong>A retrospective review was performed of pLT recipients at Cincinnati Children's Hospital Medical Center (CCHMC) and stratified patients by underlying disease to assess impact on post-transplant infectious events.</p><p><strong>Results: </strong>BA patients were youngest at pLT (12.5 months; p < 0.001) compared to other disease cohorts (HB 30.8, other 43.7). All HB patients received organs from deceased donors. In the year following pLT, 93% of the patients experienced at least one infectious event (IE). HB patients had the highest mean number of IE across disease groups (5.5 IE/patient vs. BA 4.5, other 4.0; p = 0.055), with significantly more patients with fever and neutropenia (p < 0.001) and EBV infections (p = 0.012). HB patients were more likely to develop IE earlier after pLT than non-HB groups (p = 0.013), especially Clostridioides difficile (p < 0.01) and fever and neutropenia (p < 0.01). Despite having variable IE experiences, 1-and-5-year survival across disease groups were similar.</p><p><strong>Conclusions: </strong>IE were frequently observed in HB patients after pLT, possibly related to pre-and-postoperative chemotherapy and associated neutropenia. Underlying disease may help inform targeted infection-related patient management following pLT.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 1","pages":"e70035"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047310","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":"Decisions Using Intra-Operative Gross Assessment of Fontan-Associated Liver Disease: Implications for Heart-Only Transplantation.","authors":"Diana Milagros Torpoco Rivera, Ke-You Zhang, Noelle Ebel, Rachel Bensen, Elisabeth Martin, Michael Ma, Carlos O Esquivel, Manchula Navaratnam, Seth A Hollander, David N Rosenthal, Sharon Chen","doi":"10.1111/petr.70036","DOIUrl":"https://doi.org/10.1111/petr.70036","url":null,"abstract":"<p><strong>Introduction: </strong>Intraoperative gross liver inspection at the time of transplant can be used in determination of which failing Fontan patients should undergo heart-only transplantation (HT) versus combined heart-liver transplantation (CHLT). We describe the outcomes of Fontan patients listed for CHLT who underwent HT based on the gross pathology of the liver at time of transplant.</p><p><strong>Case report: </strong>Six Fontan patients, ages 15 (IQR12,16) years, listed for CHLT received HT because of reassuring gross findings of the liver at the time of transplant. All patients survived to hospital discharge, after median hospital length of stay of 59 (IQR 42-77) days. Vasoplegia, prolonged need for milrinone because of diastolic dysfunction, acute kidney injury, and infection were common complications. Five patients had acute cellular rejection within 35 days of heart transplant. At a median of 17 (IQR 10, 19) months from HT, all continue to have abnormal findings by abdominal imaging, with development of new hepatic nodules in three patients.</p><p><strong>Summary: </strong>Intraoperative gross liver inspection at the time of transplant can enable successful HT in Fontan patients with liver disease. However, a prolonged recovery period should be anticipated, with serial post-HT liver assessments and vigilant monitoring for rejection. The long-term liver prognosis remains uncertain.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 1","pages":"e70036"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040204","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":"Pediatric Age-Prioritized Waitlisting Policy Potentially Disadvantages Adolescents on Dialysis Not Listed for Transplant Until Adulthood.","authors":"Justin A Steggerda, Steven A Wisel, Dechu Puliyanda, Helen Pizzo, Jonathan Garrison, Irene K Kim","doi":"10.1111/petr.70023","DOIUrl":"10.1111/petr.70023","url":null,"abstract":"<p><strong>Background: </strong>Current kidney transplant (KT) policies offer advantages in waiting time and organ allocation priority to pediatric patients waitlisted before 18 years old. This study evaluates the effects of this policy for patients who are on dialysis before, but not waitlisted until after, age 18.</p><p><strong>Methods: </strong>Patients aged 11-25 years and waitlisted between 2001 and 2022 for KT were identified in the OPTN STAR data file for analysis. Cohorts were defined by age and dialysis status at time of listing: Peds if < 18 yo, young adult (YA) if ≥ 18 yo; NYOD-not yet on dialysis or OD-on dialysis at time of listing, with YA groups further segregated by age at dialysis initiation. Cumulative incidence of transplant was calculated for waitlisted patients. Graft survival was assessed using Kaplan-Meier analysis and multivariable Cox proportional hazards modeling. p values < 0.01 were significant.</p><p><strong>Results: </strong>Amongst 35 764 KT registrations, candidates who initiated dialysis as pediatric patients but were not waitlisted until after turning 18 years old (YA + OD < 18) have the highest rate of nontransplantation (33.5%) and longest time on dialysis (median: 2103 days) before deceased donor (DD) KT. YA + OD < 18 patients were sixfold less likely than Peds + OD patients to undergo DDKT at 5 years after listing. YA + OD < 18 recipients had the worst post-KT graft survival of all groups at 5 years with adjusted hazard ratio of 1.477 (95% confidence interval: 1.218-1.792) compared to Peds-NYOD (p < 0.001).</p><p><strong>Conclusions: </strong>Current allocation policies significantly disadvantage candidates who initiate dialysis before, but are not listed until after age 18, and should be re-examined to address these inequities.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 1","pages":"e70023"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009753","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":"Two-Dimensional Shear Wave Ultrasound Elastography for Monitoring Pediatric Liver Transplantation: A Review of Recent Advances.","authors":"Mohamed Abdulla, Maryam Abdulla, Hakima Al-Hashimi, Hasan M Isa, Kevin Dunne, James Blackwell","doi":"10.1111/petr.70010","DOIUrl":"10.1111/petr.70010","url":null,"abstract":"<p><p>Pediatric liver transplantation (PLT) is a life-saving procedure for children with end-stage liver disease. However, post-transplant monitoring, particularly the diagnosis and prognosis of complications such as allograft fibrosis, remains challenging. Traditionally, liver biopsy has been the gold standard for assessing allograft fibrosis, despite its invasive nature and inherent procedural risks. Recently, shear wave ultrasound elastography (SWE) has seen increasing use as a noninvasive method to provide real-time, quantitative measurements of liver stiffness as a proxy for fibrosis. In this review, the latest developments in the use of SWE as a method to assess allograft fibrosis post-PLT are presented, including the current technical challenges associated with its clinical implementation.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 1","pages":"e70010"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896693","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}