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Pediatric Transplantation

Avgerinou Georgia, Oikonomopoulou Christina, Kaisari Aikaterini, Ioannidou Elda, Komitopoulou Anna, Paisiou Anna, Tourkantoni Natalia, Filippidou Maria, Kattamis Antonios, Vessalas George, Peristeri Ioulia, Goussetis Evgenios, Kitra Vasiliki
aUCBT is a valuable curative option in pediatric patients with refractory idiopathic SAA and no available matched sibling or unrelated donors. Experience in the use of autologous cord blood units in patients with SAA is limited and private for-profit cord blood-banking programs are controversial. We report the successful treatment of two patients with SAA, aged 15 and 24 months, with autologous cord blood combined with immunosuppression. After conditioning with 200 mg/kg cyclophosphamide and ATG, 7.5 mg/kg, 32...
November 8, 2018: Pediatric Transplantation
Ana M Calinescu, Oliver Karam, Jim C H Wilde, Marc Ansari, Valerie A McLin, Barbara E Wildhaber
In pediatric LT, anticoagulants and antiplatelet agents are regularly used to reduce the risk of vascular thrombosis. As evidence for optimal strategy is lacking, local practices vary greatly. The present survey aimed to compile an international overview of anticoagulation and antiplatelet strategies in pediatric LT. An online survey was sent to 98 pediatric LT centers in North and South America, Europe, Asia, and Australia. Twenty-four centers answered the survey. 20/24 (83%) use some sort of anticoagulation and antiplatelet therapy, yielding 20 different strategies...
November 4, 2018: Pediatric Transplantation
Angela C Chen, David N Rosenthal, Sarah C Couch, Samuel Berry, Katie J Stauffer, Jerrid Brabender, Nancy McDonald, Donna Lee, Lynsey Barkoff, Susan E Nourse, Jeffrey Kazmucha, C Jason Wang, Inger Olson, Elif Seda Selamet Tierney
BACKGROUND: Pediatric heart transplant (PedHtx) patients have increased cardiovascular risk profiles that affect their long-term outcomes and quality of life. We designed a 12- to 16-week diet and exercise intervention delivered via live video conferencing to improve cardiovascular health. Our methodology and baseline assessment of the first 13 enrolled patients are reported. METHODS: Inclusion criteria are as follows: (a) 8-19 years old; (b) heart transplant >12 months; (c) ability to fast overnight; (d) cardiac clearance by cardiologist; and (e) presence of an adult at home during exercise sessions for patients <14 years old...
November 4, 2018: Pediatric Transplantation
Margret E Bock, Amy E Bobrowski, Rukhmi Bhat
Thrombosis after kidney transplantation may result in catastrophic outcomes, including graft loss. Thrombophilia has been implicated in post-transplant thrombosis; data, however, are inconclusive on the impact of acquired and inherited thrombophilia and resultant thrombosis in renal graft recipients. We aimed to evaluate whether identifying children with thrombophilia during the pretransplant evaluation predicted post-transplant outcomes. We reviewed 100 kidney transplants performed in 100 children, aged 1-18 years, in a single-center retrospective study...
October 31, 2018: Pediatric Transplantation
Jun Kido, Shirou Matsumoto, Rieko Sakamoto, Hiroshi Mitsubuchi, Yukihiro Inomata, Kimitoshi Nakamura
Wilson disease (WD) is a disorder of copper metabolism that leads to liver cirrhosis. WD patients with a NWIS > 11 should receive LT; however, we encountered 2 WD patients with an NWIS > 11 who recovered from ALF without LT. The present report aimed to analyze cases of WD patients with a high NWIS who recovered from severe ALF and to discuss the clinical manifestations of the patients and the effects of treatments, including zinc (Zn) therapy, chelator therapy, PE, CHDF, and LT. We retrospectively evaluated the medical records of five patients (male, 2; female, 3) diagnosed with WD along with severe ALF...
October 27, 2018: Pediatric Transplantation
Laura Galluzzo Mutti, Mariana Álvarez, Mónica Siminovich, Celeste Pérez, Belén Lucero, Mary Nieto, Claudio Castaños, Dora Haag, Mariano Boglione
Cancer is a major adverse outcome of solid organ transplantation, and risks are especially high for malignancies caused by viral infections. HHV-8 is the etiologic agent of Kaposi´s sarcoma (KS). We report a case of visceral KS occurring in a 15-year-old patient after lung transplantation. The evolution was dramatically fast and interestingly, KS lesions were diffusely observed, but not in the skin. The autopsy showed the presence of numerous tumoral lesions in many organs. Microscopically, they all had very similar features, regardless of the organ affected...
October 25, 2018: Pediatric Transplantation
Abderrahim Marouane, Elisabeth A M Cornelissen, Anneliese Nusmeier, Charlotte M H H T Bootsma-Robroeks
OBJECTIVE: Blood pressure (BP) monitoring in children immediately after kidney transplantation is ideally performed with an arterial line. Accurate measurement of BP is necessary for optimal management. However, during the first days postoperative, the arterial line is removed and BP measurement is switched to a non-invasive device. The aim of this study was to determine the accuracy and reliability of the automated oscillometric device compared to invasive arterial BP (IBP) monitoring in patients after renal transplantation in pediatric intensive care unit (PICU)...
October 25, 2018: Pediatric Transplantation
Karel Vondrak, Anil Dhawan, Francesco Parisi, Ryszard Grenda, Dominique Debray, Stephen D Marks, Nicholas J A Webb, Alain Lachaux, Gbenga Kazeem, Nasrullah Undre
Phase 2, parallel-group, multicenter, open-label, 4-week study, comparing PK of PR-T vs IR-T in de novo pediatric patients undergoing primary kidney, liver, or heart transplantation. Patients randomized 1:1 to receive once daily, PR-T-, or twice-daily, IR-T-based regimens; dose adjustments permitted after Day 1. Twenty-four-hour PK profiles collected on Days 1, 7, and 28. Primary endpoint: tacrolimus AUC24 . Secondary end points included tacrolimus C24 and Cmax . Endpoints compared between PR-T and IR-T on Days 1, 7, and 28...
October 24, 2018: Pediatric Transplantation
Csaba Kassa, Péter Reményi, János Sinkó, Krisztián Kállay, Gabriella Kertész, Gergely Kriván
Primary CNS PTLD is an extremely rare complication after allogeneic HSCT. At our centre, an 11-year-old patient developed nausea, vomiting, and diplopy on day +82 following HSCT. On brain MRI, multiple white matter lesions were seen. Histology showed a diffuse large B-cell lymphoma with high load of EBV in tissue. Despite stopping immunosuppression, treatment with EBV-specific cytotoxic T cells, systemic rituximab, HD-MTX, and intrathecal chemotherapy, progression was observed. With a combination of HD-MTX and cytarabine, only a partial response could be achieved...
October 21, 2018: Pediatric Transplantation
Soichi Narumoto, Seisuke Sakamoto, Kengo Sasaki, Yoshihiro Hirata, Akinari Fukuda, Toru Uchiyama, Rie Irie, Takako Yoshioka, Mureo Kasahara
Desensitization with RTX has been broadly introduced in adult LT across the ABO blood type barrier. For pediatric LT, the prophylactic use of RTX has not been standardized, especially for children under 2 years of age. A 20-month-old girl with BA underwent living donor LT from her ABO-I mother. On POD 6, she developed combined T cell-mediated and AMRs. Steroid bolus injection was immediately introduced, followed by antibody-depleting therapy with PE and IVIG. Based on a peripheral blood lymphocyte analysis by fluorescence-activated cell sorting, ATG and RTX were introduced for refractory rejection...
October 19, 2018: Pediatric Transplantation
Brian Ezekian, Michael S Mulvihill, Paul M Schroder, Brian F Gilmore, Harold J Leraas, Brian C Gulack, Sarah Jane Commander, Alisha M Mavis, Susan G Kreissman, Stuart J Knechtle, Elisabeth T Tracy, Andrew S Barbas
PURPOSE: Improvement in outcomes of LT for pediatric HB and HCC has been reported in small series. We analyzed national outcomes and changes in donor, recipient, and perioperative factors over time that may contribute to survival differences. METHODS: The UNOS database was queried for patients age <21 years that underwent LT for a primary diagnosis of HB or HCC (1987-2017). Subjects were divided into historic (transplant before 2010) and contemporary (transplant after 2010) cohorts...
October 19, 2018: Pediatric Transplantation
Clayton Mowrer, Brian R Lee, Rakesh Goyal, Rangaraj Selvarangan, Jennifer E Schuster
Rhinoviruses are commonly detected in symptomatic and asymptomatic children prior to HCT. Unlike pre-HCT detection of other respiratory viruses, it is not known whether RV detection, with or without clinical symptoms, is associated with worse outcomes in children post-HCT. In a retrospective study of children undergoing allogeneic HCT from January 2009 to February 2015, 91 children underwent allogeneic HCT, and 62 children had RPP testing within 30 days pre-HCT. Fifty-six (90%) children had either no pathogen (n = 34, 55%) or single RV detection (n = 22, 35%), which was the most common pathogen identified...
October 19, 2018: Pediatric Transplantation
Megan Culler Freeman, Carolyn B Coyne, Michael Green, John V Williams, Laurie A Silva
Recent years have brought a rise in newly emergent viral infections, primarily in the form of previously known arthropod-transmitted viruses that have increased significantly in both incidence and geographical range. Of particular note are DENV, CHIKV, and ZIKV, which are transmitted mostly by Aedes species of mosquitoes that exhibit a wide and increasing global distribution. Being important pathogens for the general population, these viruses have the potential to be devastating in the international transplant community, with graft rejection and death as possible outcomes of infection...
October 19, 2018: Pediatric Transplantation
Brian H Morray, Erin L Albers, Thomas K Jones, Mariska S Kemna, Lester C Permut, Yuk M Law
BACKGROUND: The hybrid stage 1 palliation for hypoplastic left heart syndrome (HLHS) was first described in 1993 as a bridge to heart transplant for HLHS. There are limited data on this strategy as primary heart transplantation for HLHS has become less common. METHODS: This is an observational, single-center study comparing pre- and post-transplant outcomes of patients listed for transplant following hybrid palliation with those following surgical stage 1 palliation...
October 19, 2018: Pediatric Transplantation
Eric J Monroe, Arthie Jeyakumar, Christopher R Ingraham, Giri Shivaram, Kevin S H Koo, Evelyn K Hsu, Andre A S Dick
OBJECTIVE: To investigate Doppler US and catheter venogram correlates to improve detection of transplant HVOO and avoid unnecessary invasive imaging procedures. MATERIALS AND METHODS: A retrospective review was performed in all pediatric OLT patients undergoing catheter venography of the hepatic veins between 2007 and 2017 at a single large tertiary pediatric liver transplant institution. RESULTS: Forty-four transplant hepatic venograms in 32 OLT patients were included (mean 1...
October 19, 2018: Pediatric Transplantation
Vibeke Naeser, Andreas Hjelm Brandt, Bo Nyhuus, Lise Borgwardt, Marianne Hørby Jørgensen, Allan Rasmussen
BACKGROUND: Increased risk of cardiovascular diseases is well described after adult liver transplantation, whereas the risk in the pediatric population still is discussed. The aim of this study was to investigate the prevalence of metabolic syndrome in pediatric liver transplant recipients and whether measurements of carotid intima media thickness and pulse wave velocity were increased compared to healthy controls. METHODS: We included 42 pediatric liver transplantation recipients and examined them for markers of metabolic syndrome, liver fibrosis measured by shear wave velocity, body fat measured by DXA scans and carotid intima-media thickness, and pulse wave velocity (n = 41 for the carotid scans)...
October 19, 2018: Pediatric Transplantation
Hsi-Yang Wu, Waldo Concepcion, Paul C Grimm
PURPOSE: The treatment of VUR in children with UTI has changed significantly, due to studies showing that antibiotic prophylaxis does not decrease renal scarring. As children with kidney transplants are at higher risk for UTI, we investigated if select patients with renal transplant VUR could be managed without surgery. MATERIALS AND METHODS: A total of 18 patients with VUR into their renal grafts were identified, and 319 patients underwent transplantation from 2006 to 2016...
October 15, 2018: Pediatric Transplantation
Michael E Chua, Jin Kyu Kim, Michele Gnech, Jessica M Ming, Bisma Amir, Nicolas Fernandez, Armando J Lorenzo, Walid A Farhat, Diane Hebert, Joana Dos Santos, Martin A Koyle
Our study aims to assess the clinical implication of RAV/rBSA ratio in PRT as a predictor for attained renal function at 1 year post-transplantation and its association with surgical complications. A retrospective cohort was performed for PRT cases from January 2000 to December 2015 in our institution. Extracted clinical information includes the recipient's demographics, donor type, renal allograft characteristics, arterial, venous and ureteral anastomoses, vascular anastomosis time while kidney off ice, overall operative time, and estimated blood loss...
October 12, 2018: Pediatric Transplantation
Markus Ameres, Michael Melter, Robert Zant, Stefan Schilling, Tobias Geis
pLT is a highly standardized therapy for children with end-stage liver disease and liver-based metabolic diseases. However, NCs after transplantation occur and especially younger children are considered as more vulnerable and susceptible to NCs. Up to now, detailed data particularly for the very young age group do not exist. We therefore retrospectively studied NCs in children after pLT under age of 24 months. Forty children aged between 19 days and 22 months were evaluated according to type of NC and potential risk factors...
October 12, 2018: Pediatric Transplantation
Kristen Sgambat, Sarah Clauss, Asha Moudgil
BACKGROUND: Kidney transplant recipients are at high risk for CV morbidity. However, the measure of obesity that best predicts CV risk has not been established. OBJECTIVE: A prospective, controlled study was conducted to compare the ability of BMI, WC, and WHr to identify CV risk in pediatric kidney transplant recipients. METHODS: Transplant recipients, aged 3-20 years, had echocardiogram, CIMT, BMI, WC, WHr, blood pressure, lipids, and leptin measured...
October 7, 2018: Pediatric Transplantation
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