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Pediatric Transplantation

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https://www.readbyqxmd.com/read/29785805/fairness-severe-intellectual-disability-and-the-special-case-of-transplantation
#1
REVIEW
Aaron Wightman, Aviva Goldberg, Douglas Diekema
Children with severe intellectual disability have historically been excluded from solid organ transplantation. The purpose of this article was to review the arguments for excluding this population, including claims of poorer recipient and graft survival, a lower QoL as pediatric recipients become adults, and poorer outcomes for other, more deserving pediatric transplant candidates, and make the case that these arguments are no longer persuasive. We will argue that pediatric transplant centers for reasons of social justice, value of relationships, power differential, and fairness should generally not consider intellectual ability or disability as a criterion when making decisions regarding organ transplant eligibility...
May 21, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29777573/quantiferon-cytomegalovirus-assay-a-potentially-useful-tool-in-the-evaluation-of-cmv-specific-cd8-t-cell-reconstitution-in-pediatric-hematopoietic-stem-cell-transplant-patients
#2
Bilio Paouri, Alexandra Soldatou, Eftihia Petrakou, Maria Theodosaki, Charalampos Tsentidis, Katerina Kaisari, Christina Oikonomopoulou, Minos Matsas, Eugenios Goussetis
Pediatric HSCT recipients are at high risk for CMV reactivation due to their immature immune system and therapy following transplantation. Reconstitution of CMV-specific T-cell immunity is associated with control and protection against CMV. The clinical utility of monitoring CMV-specific CMI to predict CMV viremia in pediatric HSCT patients using the Quantiferon-CMV (QIAGEN® ) test was investigated prospectively. Thirty-seven pediatric allogeneic HSCT recipients were enrolled from 3/2010-6/2012. CMV viremia was detected via weekly real-time PCR...
May 18, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29774622/pediatric-marginal-donor-hearts-trends-in-us-national-use-2005-2014
#3
Adam K Morrison, Charitha Gowda, Dmitry Tumin, Christina M Phelps, Don Hayes, Joseph Tobias, Robert J Gajarski, Deipanjan Nandi
Pediatric patients awaiting heart transplant face high mortality rates due to donor organ shortages, including non-use of marginal donor hearts. We examined national trends in pediatric marginal donor heart use over time. UNOS data were queried for heart donors <18 years from 2005 to 2014. The proportion of donor hearts considered marginal was determined using previously cited marginal characteristics: left ventricular ejection fraction (LVEF) <50%, use of ≥2 inotropes, cerebrovascular death, CDC high-risk status, and eGFR < 30 mL/min/1...
May 17, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29767471/converting-immunosuppression-from-an-oral-suspension-to-a-granule-formulation-of-tacrolimus-in-pediatric-renal-transplant-recipients
#4
Georgia Malakasioti, Christine Booth, Stephen D Marks
OS of tacrolimus prepared from tacrolimus powder is not licensed for children. A licensed GF for OS allows flexibility for body weight-based dose adjustments. This study aimed at exploring the efficacy of conversion from OS to the GF of tacrolimus in stable pediatric renal transplant recipients. Records of 25 pediatric renal transplant recipients aged under 18 years who were switched from an unlicensed tacrolimus OS to GF were reviewed. At day 0, 1 week, and 4-8 weeks post-conversion, there were no differences regarding daily tacrolimus dose (3...
May 16, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29761937/-mirror-mirror-on-the-wall-%C3%A2-pediatric-liver-transplantation-in-the-case-of-situs-inversus-totalis-with-a-disrupted-inferior-vena-cava
#5
Colston A Edgerton, Megan Gross, Nagraj Kasi, Winston Hewitt, Sara Edmondson, Vinayak S Rohan, Satish N Nadig
We present the unique case of a 15-month-old male born with biliary atresia and situs inversus totalis and disrupted inferior vena cava who underwent a successful liver transplantation. The patient had previously undergone a failed Kasai procedure and presented with persistent hyperbilirubinemia. The patient was transplanted with a left lateral segment donor having standard arterial anatomy. Technical considerations included identifying completely replaced arterial anatomy in the recipient from the superior mesenteric artery and creating a branch patch between the gastroduodenal artery and HA, anastomosing the donor left hepatic vein to confluences of the donor left, middle, and right hepatic veins, using a "lazy-S" configuration of portal vein anastomosis, and suspending the allograft to the abdominal wall...
May 15, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29761899/the-use-of-hepatitis-b-immunoglobulin-with-or-without-hepatitis-b-vaccine-to-prevent-de-novo-hepatitis-b-in-pediatric-recipients-of-anti-hbc-positive-livers
#6
Noriyo Yamashiki, Atsushi Yoshizawa, Yoshihide Ueda, Toshimi Kaido, Hideaki Okajima, Hiroyuki Marusawa, Hiroshi Seno, Shinji Uemoto
Prophylactic measures are used to reduce DNHB after HBsAg-negative patients receive anti-HBc-positive liver grafts. This study investigated the incidence of DNHB and clinical outcomes in pediatric LT recipients under HBIG prophylaxis, with or without hepatitis B vaccination. Between 1995 and 2013, 51 HBsAg-negative pediatric recipients underwent living-donor LT from anti-HBc-positive donors. The median (range) age was 4 (0.1-17) years, 23 (45%) were male, and 71% were negative for both anti-HBc and anti-HBc...
May 15, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29761856/autoimmune-thyroiditis-following-hla-matched-sibling-hematopoietic-stem-cell-transplantation-for-wiskott-aldrich-syndrome
#7
Tristan Knight, Katherine Kotz, Süreyya Savaşan
WAS is a fatal X-linked combined immunodeficiency syndrome, the only cures for which are HSCT or gene therapy. AID occur in up to 72% of patients with WAS who do not receive HSCT, likely arising secondary to impaired multilineage immune autoregulatory function; AITD is not typically seen. In this article, we describe the case of a male patient who underwent HLA-matched HSCT for WAS at the age of 5 months, with his sister (a WAS carrier) acting as his donor and subsequently developed AITD 12 months post-transplant, with marked elevation of antithyroid peroxidase antibody titer...
May 15, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29761829/pretransplant-trends-in-%C3%AE-fetoprotein-levels-as-a-predictor-of-recurrence-after-living-donor-liver-transplantation-for-unresectable-hepatoblastoma-a-single-institution-experience
#8
Kaori Isono, Yuki Ohya, Kwang-Jong Lee, Shintaro Hashimoto, Masashi Kadohisa, Masataka Sakisaka, Keiichi Uto, Shintaro Hayashida, Hidekazu Yamamoto, Hirotoshi Yamamoto, Yasuhiko Sugawara, Yukihiro Inomata
LT is a practical therapeutic alternative for unresectable hepatoblastoma; however, deciding when to perform LT is difficult. The aim of this study was to optimize the timing of LT for hepatoblastoma using pretransplant trends in AFP levels. Trends in pretransplant AFP levels and their influence on post-transplant outcomes were retrospectively evaluated. All patients who underwent living donor LT for hepatoblastoma in our institution since 2002 were included. Variables analyzed included history of prior tumor resection, pretransplant AFP responses to chemotherapy, metastatic disease at diagnosis, and post-transplant chemotherapy...
May 15, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29749699/histological-findings-in-protocol-biopsies-following-pediatric-liver-transplant-low-incidence-of-abnormalities-at-5-years
#9
Amin Sheikh, Kai Y Chau, Helen M Evans
Histological abnormalities, including chronic hepatitis, fibrosis, and steatosis, are increasingly reported in liver biopsies of children after LT. These changes may be progressive and represent a form of rejection. Liver biochemistry is often initially normal. Our LT program began in 2002, utilizing tacrolimus and low-dose steroids for the first year post-LT. Patients undergo a protocol biopsy at 1 year post-LT prior to stopping steroids, then at 5 years and every 5 years thereafter. Target tacrolimus levels are 5-8 μg/L and 3-5 μg/L after 3 and 12 months, respectively...
May 11, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29745058/post-transplant-lymphoproliferative-disorder-in-pediatric-intestinal-transplant-recipients-a-literature-review
#10
REVIEW
Kaitlin Stanley, Erika Friehling, Sarangarajan Ranganathan, George Mazariegos, Linda M McAllister-Lucas, Rakesh Sindhi
Intestinal transplantation is a successful treatment for children with intestinal failure, but has many potential complications. PTLD, a clinically and histologically diverse malignancy, occurs frequently after intestinal transplantation and can be fatal. The management of this disease is particularly challenging. The rejection-prone intestinal allograft requires high levels of immunosuppression, a precondition for PTLD. While EBV infection clearly plays a role in disease pathogenesis, the relatively naïve immune system of children is another likely contributor...
May 10, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29744996/hematopoietic-stem-cell-transplantation-without-in-vivo-t-cell-depletion-for-pediatric-aplastic-anemia-a-single-center-experience
#11
Sidan Li, Bin Wang, Lingling Fu, Yilin Pang, Guanghua Zhu, Xuan Zhou, Jie Ma, Yan Su, Maoquan Qin, Runhui Wu
For young patients, HLA-MRD HSCT is the first-line treatment of SAA. However, due to China's birth control policy, few patients could find suitable sibling donors and HLA-MUD. More and more transplantation centers have used Haplo-D as the donor source for young adult and pediatric patients. However, studies with larger amount of pediatric patients are rare. We retrospectively analyzed the data of children with AA who were treated with allogeneic HSCT and compared the therapeutic efficacy of Haplo-HSCT and MRD/MUD group...
May 10, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29744993/paroxysmal-complete-atrioventricular-block-in-pediatric-heart-transplant-recipients-following-cardiac-catheterization-a-case-series
#12
Defne A Magnetta, Brian Feingold, Lee B Beerman, Brian Blasiole, Gaurav Arora
Late-onset paroxysmal AVB has been described as a rare complication after HT and has been associated with AR or CAV. We describe 4 pediatric HT recipients who developed paroxysmal AVB hours after routine cardiac catheterization in the absence of AR, CAV, or underlying conduction system disease. Four pediatric HT recipients who were >1 year post-transplant had episodes of paroxysmal AVB hours after surveillance cardiac catheterization with EMB. Telemetry demonstrated high-grade block, ranging from 2:1 AVB to complete AVB without ventricular escape for several seconds...
May 10, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29744988/behavioral-health-care-in-solid-organ-transplantation-in-a-pediatric-setting
#13
Katharine Thomson, Kristine McKenna, Katherine Bedard-Thomas, Melisa Oliva, Patricia Ibeziako
This study examined the demographic, medical, and psychiatric characteristics of transplant patients across organ groups seen by transplant psychology/psychiatry clinicians at a pediatric institution between 2008 and 2014. Chart reviews were conducted to better understand the behavioral health care provided to SOT patients and the role of transplant-dedicated psychology and psychiatry clinicians. Transplant psychology/psychiatry was consulted a total of 1060 times on 399 unique SOT patients over a 6-year period...
May 10, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29733526/the-importance-of-qualitative-and-quantitative-regional-wall-motion-abnormality-assessment-at-rest-in-pediatric-coronary-allograft-vasculopathy
#14
Nathalie Dedieu, Miguel Silva Vieira, Matthew Fenton, James Wong, Rene Botnar, Michael Burch, Gerald Greil, Tarique Hussain
CAV remains one of the main limiting factors for survival in children after heart transplantation. In this study, we explored the incremental value of routine CMR for evaluation and detection of CAV using qualitative and quantitative analysis of regional and global myocardial function and strain. This was a prospective imaging biomarker validation trial. Twenty-two patients (11 male), aged between 10 and 17 years (median 14 years) post-heart transplantation, were prospectively enrolled and underwent CMR in addition to their biennial review workup with Echo, angiography, and IVUS...
May 7, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29733490/the-efficacy-of-serum-brain-natriuretic-peptide-for-the-early-detection-of-portopulmonary-hypertension-in-biliary-atresia-patients-before-liver-transplantation
#15
Koichiro Yoshimaru, Toshiharu Matsuura, Yoshiaki Takahashi, Yusuke Yanagi, Hazumu Nagata, Shouichi Ohga, Tomoaki Taguchi
Severe portopulmonary hypertension (POPH) is a contraindication for liver transplantation (LT) because of the high risk of postoperative heart failure. The early detection of POPH is important for patients with biliary atresia (BA). Brain natriuretic peptide (BNP) is known to be correlated with liver fibrosis in patients with liver cirrhosis. The aim of this study was to elucidate the efficacy of BNP measurement for the follow-up of patients with BA. Thirty-two patients with BA were identified from September 2011 to December 2016...
May 7, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29733487/the-prognostic-value-of-urinary-chemokines-at-6-months-after-pediatric-kidney-transplantation
#16
Claire Mockler, Atul Sharma, Ian W Gibson, Ang Gao, Alexander Wong, Julie Ho, Tom D Blydt-Hansen
Pediatric kidney transplantation is lifesaving, but long-term allograft survival is still limited by injury processes mediated by alloimmune inflammation that may otherwise be clinically silent. Chemokines associated with alloimmune inflammation may offer prognostic value early post-transplant by identifying patients at increased risk of poor graft outcomes. We conducted a single-center prospective cohort study of consecutive pediatric kidney transplant recipients (<19 years). Urinary CCL2 and CXCL10 measured at 6 months post-transplant were evaluated for association with long-term eGFR decline, allograft survival, and concomitant acute cellular rejection histology...
May 7, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29729082/a-case-series-of-perioperative-variables-in-relation-to-short-term-outcomes-in-pediatric-renal-transplant-recipients
#17
Celine Y Y Goh, Helen Hume-Smith, Nicos Kessaris, Stephen D Marks
Multiple perioperative variables have been shown in existing literature to influence long-term outcomes of pediatric RTx, such as allograft survival. Their impact on short-term outcomes is not as well-documented. This case series aims to investigate the effects of nine perioperative variables on two short-term outcomes in pRTR: 1-week post-operative eGFR and post-operative LOS. A total of 73 pRTR transplanted over 3 years from 2012 to 2014 at a single center were studied retrospectively and statistical analyses were performed...
May 5, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29729061/side-effects-and-efficacy-of-renal-sparing-immunosuppression-in-pediatric-liver-transplantation-a-single-center-matched-cohort-study
#18
Christoph Leiskau, Jeremy Rajanayagam, Eva-Doreen Pfister, Imeke Goldschmidt, Norman Junge, André Karch, Christian Lerch, Nicolas Richter, Frank Lehner, Harald Schrem, Ulrich Baumann
Immunosuppressive combination therapy with MMF can reduce CNI associated nephrotoxicity. We investigated effectiveness and safety of de novo MMF-tacrolimus based immunosuppression after pLTx. Patients after pLTx receiving immunosuppression with MMF/tacrolimus (MMF/TAC) were compared to retrospectively selected age- and diagnosis-matched patients with tacrolimus monotherapy (TAC) and cyclosporine/prednisolone therapy (CSA) (19 patients each, n = 57). Effectiveness, renal function and side effects were analyzed for 1 year after pLTx...
May 5, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29729067/pathological-antibody-mediated-rejection-in-pediatric-heart-transplant-recipients-immunologic-risk-factors-hemodynamic-significance-and-outcomes
#19
Seth A Hollander, David M Peng, Marcos Mills, Gerald J Berry, Marny Fedrigo, Doff B McElhinney, Christopher S Almond, David N Rosenthal
Biopsy-diagnosed pAMR has been observed in over half of pediatric HT recipients within 6 years of transplantation. We report the incidence and outcomes of pAMR at our center. All endomyocardial biopsies for all HT recipients transplanted between 2010 and 2015 were reviewed and classified using contemporary ISHLT guidelines. Graft dysfunction was defined as a qualitative decrement in systolic function by echocardiogram or an increase of ≥3 mm Hg in atrial filling pressure by direct measurement. Among 96 patients, pAMR2 occurred in 7 (7%) over a median follow-up period of 3...
May 4, 2018: Pediatric Transplantation
https://www.readbyqxmd.com/read/29726081/liver-transplantation-for-neonatal-onset-citrullinemia
#20
Roshni Vara, Anil Dhawan, Maesha Deheragoda, Stephanie Grünewald, Germaine Pierre, Nigel D Heaton, Hector Vilca-Melendez, Nedim Hadžić
Citrullinemia or ASS deficiency in its classical form presents in the neonatal period with poor feeding, hyperammonemia, encephalopathy, seizures, and if untreated can be fatal. Despite advances in medical therapy, neurocognitive outcomes remain suboptimal. LT has emerged as a potential management option. A retrospective single-center review identified 7 children with a median age of 1.1 years (range, 0.6-5.8) at referral. Five children presented clinically, and 2 were treated prospectively from birth due to positive family history...
May 3, 2018: Pediatric Transplantation
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