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Pediatric Transplantation

Rolla F Abu-Arja, Jamie L Dargart, Rajinder P S Bajwa, Samir B Kahwash, Jeffery J Auletta, Hemalatha G Rangarajan
AML with the RAM immunophenotype is associated with extremely poor prognosis. We report a rare case of monozygotic twins presenting simultaneously at the age of 2 years with RAM AML. Each twin underwent a myeloablative 7/10 unrelated umbilical cord blood transplant. Pretransplant Twin A's bone marrow was negative for MRD by flow cytometry (<0.01%) unlike Twin B's bone marrow (0.07%). Twin A is alive in remission 3 years from transplant. Twin B developed primary graft failure, but subsequently rescued with a haploidentical stem cell transplant...
September 15, 2018: Pediatric Transplantation
Daniel E Dulek, Annabelle de St Maurice, Natasha B Halasa
Infections significantly impact outcomes for solid organ and hematopoietic stem cell transplantation in children. Vaccine-preventable diseases contribute to morbidity and mortality in both early and late posttransplant time periods. Several infectious diseases and transplantation societies have published recommendations and guidelines that address immunization in adult and pediatric transplant recipients. In many cases, pediatric-specific studies are limited in size or quality, leading to recommendations being based on adult data or mixed adult-pediatric studies...
September 12, 2018: Pediatric Transplantation
Rebecca Pellett Madan, Upton D Allen, Michael Green, Britta Höcker, Marian G Michaels, Gustavo Varela-Fascinetto, Lara Danziger-Isakov
The prevention and management of cytomegalovirus (CMV) remain challenging in children who have undergone solid organ transplantation, despite the availability of effective antiviral medications and sensitive diagnostic assays. The primary objective of this invited commentary is to provide an updated and multidisciplinary approach to persistently challenging CMV cases that commonly occur in pediatric transplantation candidates and recipients, including cases for which published data are frequently lacking.
September 10, 2018: Pediatric Transplantation
Sandar Min, Tanya Papaz, Myriam Lafreniere-Roula, Nadya Nalli, Hartmut Grasemann, Steven M Schwartz, Binita M Kamath, Vicky Ng, Rulan S Parekh, Cedric Manlhiot, Seema Mital
BACKGROUND: Tacrolimus pharmacokinetics are influenced by age and CYP3A5 genotype with CYP3A5 expressors (CYP3A5*1/*1 or *1/*3) being fast metabolizers. However, the benefit of genotype-guided dosing in pediatric solid organ transplantation has been understudied. OBJECTIVE: To determine whether age and CYP3A5 genotype-guided starting dose of tacrolimus result in earlier attainment of therapeutic drug concentrations. SETTING: Single hospital-based transplant center...
September 3, 2018: Pediatric Transplantation
Jamie K Harrington, Lindsay R Freud, Kristal L Woldu, Anna Joong, Marc E Richmond
RV systolic function is important early after HT; however, it has not been critically assessed in children using quantitative measures. The aim of this study was to describe the most validated and commonly used quantitative echocardiographic measures of RV systolic function early after pediatric HT and to assess associations with qualitative function evaluation and clinical factors. RV systolic function was quantified on the first post-HT echocardiogram >24 hours after cardiopulmonary bypass using two-dimensional TAPSE, Tricuspid annular S', FAC, and MPI...
September 3, 2018: Pediatric Transplantation
Chiara Grimaldi, Fabrizio di Francesco, Fabrizio Chiusolo, Roberta Angelico, Lidia Monti, Paolo Muiesan, Jean de Ville de Goyet
Vascular complications are a major cause of patient and graft loss after LTs. The aim of this study was to evaluate the effect of a multimodal perioperative strategy aimed at reducing the incidence of vascular complications. A total of 126 first isolated LTs-performed between November 2008 and December 2015-were retrospectively analyzed. A minimum follow-up period of 24 months was analyzable for 124/126 patients (98.4%). The aggressive preemptive strategy consisted of identifying and immediately managing any problem and any abnormality in the vascular flow, in any of the hepatic vessels, and at any time after the liver graft revascularization...
September 1, 2018: Pediatric Transplantation
Vanessa Fabrizio, Amy Wahlquist, Elise Hill, Elizabeth Williams, Cindy Kramer, Jennifer Jaroscak, Angie Duong, Elizabeth Garrett-Mayer, Michelle Hudspeth
Hematopoietic stem cell graft cellular composition has been generally accepted to impact outcomes. Recent studies question this hypothesis. We conducted a single-center retrospective study of sixty-one pediatric BMT recipients for malignant (68%) and nonmalignant diseases (32%) examining effects of graft composition on engraftment, acute GVHD, chronic GVHD, and survival at day 100 and 1 year. Grafts contained a median of 3.63 x  08 TNC/kg (range: 0.031-10.31 x 108 TNC/kg) and 4.09 x 106 CD34+ /kg (range: 0...
August 29, 2018: Pediatric Transplantation
Oscar K Serrano, Ananta S Bangdiwala, David M Vock, Srinath Chinnakotla, Ty B Dunn, Erik B Finger, Raja Kandaswamy, Timothy L Pruett, John S Najarian, Arthur J Matas, Blanche Chavers
BACKGROUND: KT recipients have increased the risk of CVD. The incidence of post-transplant CVEs among pediatric recipients has not been well-characterized. PATIENTS AND METHODS: Between 1963 and 2015, 884 pediatric (age: 0-17 years old) recipients received 1058 KTs at our institution. The cumulative incidence of CVEs was analyzed. Statistical models were used to estimate risk factors for developing post-transplant CVEs. RESULTS: Overall median patient survival was 33 years (IQR: 18...
August 27, 2018: Pediatric Transplantation
Lauren Jarchin, Jaime Chu, Megan Januska, Pamela Merola, Ronen Arnon
Hemophagocytic lymphohistiocytosis (HLH), a rare condition characterized by immune dysfunction with uncontrolled activation of macrophages and hypersecretion of cytokines, has only been reported in a small number of pediatric patients following solid organ transplant (SOT). The diagnosis of HLH after SOT is especially difficult, as several of the diagnostic criteria, including fever, splenomegaly, and cytopenias, are nonspecific and can be seen with other post-transplant complications. Autoimmune hemolytic anemia (AIHA) has also been reported after pediatric SOT and is thought to be related to immunosuppression, specifically tacrolimus...
August 20, 2018: Pediatric Transplantation
John A Geha, N Thao N Galvan, Abbas Rana, Joseph D Geha, Christine A O'Mahony, John A Goss
No abstract text is available yet for this article.
August 13, 2018: Pediatric Transplantation
Björn van Sambeek, Martin Flattery, Richard Mitchell, Richard De Abreu Lourenco
Use of TCR α+ β+ /CD19+ depletion in a pediatric setting has improved the utility of haploidentical donor material, resulting in better rates of engraftment, lower rates of graft vs host disease (GVHD), and improved transplant-related mortality. There are currently no data available on the costs of TCR α+ β+ /CD19+ depletion. This study assessed the costs of acquiring and preparing TCR α+ β+ /CD19+ depleted haploidentical donor cells in comparison with matched unrelated donor (MUD) products for use in pediatric patients in Australia...
August 9, 2018: Pediatric Transplantation
Brandon Chatani, Jennifer Garcia, Chiara Biaggi, Thiago Beduschi, Akin Tekin, Rodrigo Vianna, Kristopher Arheart, Ivan A Gonzalez
BIs are ubiquitous among the pediatric intestinal transplant patient population. Personalizing postoperative prophylaxis antibiotic regimens may improve outcomes in this population. A retrospective analysis of all pediatric patients who underwent intestinal transplantation was evaluated to compare standardized and tailored regimens of antibiotics provided as prophylaxis postoperatively. Patients in the standard group have both shorter time to and higher rate of BIs, which was statistically significant (P < 0...
August 9, 2018: Pediatric Transplantation
Luisa Sisinni, Mercedes Pineda, Maria Josep Coll, Laura Gort, Eulalia Turon, Montserrat Torrent, Anna Ey, Eva Tobajas, Isabel Badell
Mucopolysaccharidosis type VII (MPS VII) is an inherited disease characterized by the cellular accumulation of undegraded GAGs due to the deficiency of the lysosomal enzyme β-glucuronidase. We describe a case of a 2-year-old female affected by a moderate form of MPS VII and submitted twice to HSCT with the aim of stabilizing skeletal problems and preventing neurocognitive alterations. The child underwent a second transplantation due to the rejection of the graft after a reduced-intensity conditioning in the first transplant...
August 9, 2018: Pediatric Transplantation
Annabelle de St Maurice, Natasha Halasa
The 2017-18 influenza season brought record numbers of cases in both the Northern and Southern hemispheres, resulting in high rates of influenza-related hospital admission and death. Estimated efficacy of flu vaccine was low against the most common circulating strain, influenza A (H3N2). Decreased efficacy may be due to changes in circulating virus or mutations that occur in the vaccine strain during the manufacturing process.
August 3, 2018: Pediatric Transplantation
Kenice Ferguson-Paul, Catherine Park, Sandra Childress, Sandra Arnold, Bettina Ault, Bindiya Bagga
BACKGROUND: We report a case series of histoplasmosis in KTx patients in a children's hospital in an endemic area. METHODS: All KTx cases from January 1, 2002, to August 31, 2016, were reviewed to identify those with disseminated histoplasmosis. RESULTS: The attack rate of histoplasmosis among our KTx patients was 6.9 per 100 cases. The median age at the time of diagnosis was 16 years (11-18). Comorbidities included glomerulosclerosis (3), medullary cystic disease (1), and obstructive uropathy (2) and HIV (1)...
August 3, 2018: Pediatric Transplantation
David M Peng, Alaina K Kipps, Michal Palmon, Theresa A Tacy, Lynn F Peng, Seth A Hollander, Doff B McElhinney
Per protocol, our institution obtains echocardiograms immediately after each EMB to rule out procedural complication. We sought to determine the incidence of echocardiogram-detected cardiac perforation and TV injury and to evaluate the utility of routine screening echocardiogram after each EMB in the current era. At a single center, 99% (1917/1942) EMB performed in 162 patients were immediately followed by an echocardiogram per protocol. There were five newly diagnosed pericardial effusions, and only one required pericardiocentesis...
August 3, 2018: Pediatric Transplantation
Krupa R Mysore, Ryan W Himes, Abbas Rana, Jun Teruya, Moreshwar S Desai, Poyyapakkam R Srivaths, Kimberly Zaruca, Andrea Calvert, Danielle Guffey, Charles G Minard, Eda Morita, Lisa Hensch, Michael Losos, Vadim Kostousov, Shiu-Ki Rocky Hui, Jordan S Orange, John A Goss, Sarah K Nicholas
ABO-ILT have re-emerged as an alternate option for select patients awaiting transplant. However, treatment protocols for children undergoing deceased donor ABO-ILT are not standardized. We implemented a novel IS protocol for children undergoing deceased donor ABO-ILT based on pretransplant IH titers. Children with high pretransplant IH titers (≥1:32) underwent an enhanced IS protocol including plasmapheresis, rituximab, IVIG, and mycophenolate, while children with IH titers ≤1:16 received steroids and tacrolimus...
August 2, 2018: Pediatric Transplantation
Seishiro Nodomi, Katsutsugu Umeda, Itaru Kato, Satoshi Saida, Hidefumi Hiramatsu, Eri Ogawa, Atsushi Yoshizawa, Shinya Okamoto, Hideaki Okajima, Shinji Uemoto, Souichi Adachi
No studies have examined CMV infection in pediatric patients with HB receiving LT. Here, we retrospectively analyzed the incidence of and risk factors for CMV infection in 24 pediatric patients with HB who underwent LT between 1997 and 2015. CMV infection was monitored by measuring expression of pp65 CMV antigen for up to 4 months post-LT. CMV infection, defined as detection of at least one pp65-positive leukocyte, was detected in nine (37.5%) patients who did not develop CMV disease. Nine (47.4%) of nineteen patients who received post-LT chemotherapy experienced CMV infection; however, no CMV infection was observed in the five patients who did not receive post-LT chemotherapy (P = 0...
July 26, 2018: Pediatric Transplantation
Teng-Kuan Wang, Fang-Ying Kuo, Shin-Yi Lee, Yu-Fan Cheng, Ahmed M Elsarawy, Chih-Che Lin, Ting-Lung Lin, Chao-Long Chen
The thymus gland possesses the ability to regrow in children leading to a newly developed anterior mediastinal mass. This condition may represent a rebound phenomenon during recovery from a stressful event such as post-chemotherapy and hence was described as RTH. RTH after LT has not been well documented. We are reporting an infant with BA who underwent LT and presented with a symptomless anterior mediastinal mass, detected on follow-up imaging 6 months thereafter. Surgical partial excision was performed to rule out other differential diagnoses of a solid mass in the anterior mediastinum of an infant particularly lymphoma-that may arise as post-transplant lymphoproliferative disorder-and teratoma, as well as the other aggressive lesions such as thymoma and thymic carcinoma...
July 24, 2018: Pediatric Transplantation
Piotr Czubkowski, Jan Pertkiewicz, Małgorzata Markiewicz-Kijewska, Piotr Kaliciński, Małgorzata Rurarz, Irena Jankowska, Joanna Pawłowska
BACKGROUND AND AIM: The aim of the study was to assess efficacy and safety of endoscopic treatment in BS after pediatric LTx. METHODS: We retrospectively reviewed data of patients with DDA who developed BS and underwent ERCP. RESULTS: Of 189 transplanted patients with DDA, strictures developed in 30 (16%). In this subgroup, the median age at LTx was 14.7 (1.5-17.6) and follow-up period was 3.9 (1.3-11.3). ABS were in 76% and NABS in combination with ABS in 24% of patients...
July 24, 2018: Pediatric Transplantation
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