Pediatric Transplantation最新文献_第2页

Optimizing pediatric liver transplantation: Evaluating the impact of donor age and graft type on patient survival outcome 优化小儿肝移植手术：评估供体年龄和移植物类型对患者存活结果的影响

IF 1.3 4区医学 Q3 PEDIATRICS

Pediatric Transplantation

Pub Date : 2024-05-04 DOI: 10.1111/petr.14771

Yong K. Kwon, Pamela L. Valentino, Patrick J. Healey, Andre A. S. Dick, Evelyn K. Hsu, James D. Perkins, Mark L. Sturdevant

BackgroundWe examined the combined effects of donor age and graft type on pediatric liver transplantation outcomes with an aim to offer insights into the strategic utilization of these donor and graft options.MethodsA retrospective analysis was conducted using a national database on 0–2‐year‐old (N = 2714) and 3–17‐year‐old (N = 2263) pediatric recipients. These recipients were categorized based on donor age (≥40 vs <40 years) and graft type. Survival outcomes were analyzed using the Kaplan–Meier and Cox proportional hazards models, followed by an intention‐to‐treat (ITT) analysis to examine overall patient survival.ResultsLiving and younger donors generally resulted in better outcomes compared to deceased and older donors, respectively. This difference was more significant among younger recipients (0–2 years compared to 3–17 years). Despite this finding, ITT survival analysis showed that donor age and graft type did not impact survival with the exception of 0–2‐year‐old recipients who had an improved survival with a younger living donor graft.ConclusionsTimely transplantation has the largest impact on survival in pediatric recipients. Improving waitlist mortality requires uniform surgical expertise at many transplant centers to provide technical variant graft (TVG) options and shed the conservative mindset of seeking only the “best” graft for pediatric recipients.

背景我们研究了供体年龄和移植物类型对小儿肝移植结果的综合影响，旨在为战略性地利用这些供体和移植物选择提供见解。方法我们利用一个全国性数据库对0-2岁（N = 2714）和3-17岁（N = 2263）的小儿受者进行了回顾性分析。这些受者根据供体年龄（≥40 岁 vs <40 岁）和移植物类型进行分类。采用 Kaplan-Meier 模型和 Cox 比例危险模型对生存结果进行分析，然后进行意向治疗 (ITT) 分析，以检查患者的总体生存情况。这种差异在年轻受者（0-2 岁与 3-17 岁）中更为明显。尽管有这一发现，但 ITT 存活率分析表明，供体年龄和移植物类型对存活率并无影响，但 0-2 岁受者的存活率因年轻的活体供体移植物而有所提高。要改善等待名单上的死亡率，需要许多移植中心具备统一的外科专业知识，提供技术变异移植物（TVG）选择，并摆脱只为儿科受者寻求 "最佳 "移植物的保守心态。

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引用次数: 0

Pathology of explanted pediatric hearts: An 11‐year study. Population characteristics and implications for outcomes 被取出的小儿心脏的病理学：为期 11 年的研究。人群特征及对结果的影响

IF 1.3 4区医学 Q3 PEDIATRICS

Pediatric Transplantation

Pub Date : 2024-05-04 DOI: 10.1111/petr.14742

Takato Yamasaki, Stephen P. Sanders, Robyn J. Hylind, Caitlin Milligan, Francis Fynn‐Thompson, John E. Mayer, Elizabeth D. Blume, Kevin P. Daly, Chrystalle Katte Carreon

BackgroundAs more pediatric patients become candidates for heart transplantation (HT), understanding pathological predictors of outcome and the accuracy of the pretransplantation evaluation are important to optimize utilization of scarce donor organs and improve outcomes. The authors aimed to investigate explanted heart specimens to identify pathologic predictors that may affect cardiac allograft survival after HT.MethodsExplanted pediatric hearts obtained over an 11‐year period were analyzed to understand the patient demographics, indications for transplant, and the clinical–pathological factors.ResultsIn this study, 149 explanted hearts, 46% congenital heart defects (CHD), were studied. CHD patients were younger and mean pulmonary artery pressure and resistance were significantly lower than in cardiomyopathy patients. Twenty‐one died or underwent retransplantation (14.1%). Survival was significantly higher in the cardiomyopathy group at all follow‐up intervals. There were more deaths and the 1‐, 5‐ and 7‐year survival was lower in patients ≤10 years of age at HT. Early rejection was significantly higher in CHD patients exposed to homograft tissue, but not late rejection. Mortality/retransplantation rate was significantly higher and allograft survival lower in CHD hearts with excessive fibrosis of one or both ventricles. Anatomic diagnosis at pathologic examination differed from the clinical diagnosis in eight cases.ConclusionsSurvival was better for the cardiomyopathy group and patients >10 years at HT. Prior homograft use was associated with a higher prevalence of early rejection. Ventricular fibrosis (of explant) was a strong predictor of outcome in the CHD group. We presented several pathologic findings in explanted pediatric hearts.

背景随着越来越多的儿科患者成为心脏移植（HT）的候选者，了解移植结果的病理预测因素和移植前评估的准确性对于优化稀缺供体器官的利用和改善移植结果非常重要。作者旨在对移植的心脏标本进行调查，以确定可能影响心脏移植后心脏同种异体存活率的病理预测因素。方法对11年间获得的移植小儿心脏进行分析，以了解患者的人口统计学特征、移植适应症以及临床病理因素。CHD患者更年轻，平均肺动脉压力和阻力明显低于心肌病患者。21例患者死亡或接受了再次移植（14.1%）。在所有随访间隔中，心肌病组的存活率都明显较高。HT 年龄小于 10 岁的患者死亡人数较多，1 年、5 年和 7 年存活率较低。暴露于同种移植组织的心脏病患者早期排斥反应明显较高，但晚期排斥反应不明显。在单侧或双侧心室过度纤维化的CHD心脏中，死亡率/再移植率明显较高，异体移植存活率较低。病理检查的解剖诊断与临床诊断不同的病例有8例。结论心肌病组和使用同种异体移植物10年的患者存活率更高。既往使用过同种异体移植与早期排斥反应发生率较高有关。心室纤维化（移植体）是预测心肌病组预后的一个重要因素。我们介绍了移植小儿心脏的几种病理结果。

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引用次数: 0

Flexible bronchoscopy in pediatric lung transplantation 小儿肺移植中的柔性支气管镜检查

IF 1.3 4区医学 Q3 PEDIATRICS

Pediatric Transplantation

Pub Date : 2024-05-02 DOI: 10.1111/petr.14757

Antoinette Wannes Daou, Carolyn Wallace, Mitzi Barker, Teresa Ambrosino, Christopher Towe, David L. S. Morales, Kathryn A. Wikenheiser‐Brokamp, Don Hayes, Gregory Burg

Pediatric lung transplantation represents a treatment option for children with advanced lung disease or pulmonary vascular disorders who are deemed an appropriate candidate. Pediatric flexible bronchoscopy is an important and evolving field that is highly relevant in the pediatric lung transplant population. It is thus important to advance our knowledge to better understand how care for children after lung transplant can be maximally optimized using pediatric bronchoscopy. Our goals are to continually improve procedural skills when performing bronchoscopy and to decrease the complication rate while acquiring adequate samples for diagnostic evaluation. Attainment of these goals is critical since allograft assessment by bronchoscopic biopsy is required for histological diagnosis of acute cellular rejection and is an important contributor to establishing chronic lung allograft dysfunction, a common complication after lung transplant. Flexible bronchoscopy with bronchoalveolar lavage and transbronchial lung biopsy plays a key role in lung transplant graft assessment. In this article, we discuss the application of bronchoscopy in pediatric lung transplant evaluation including historical approaches, our experience, and future directions not only in bronchoscopy but also in the evolving pediatric lung transplantation field. Pediatric flexible bronchoscopy has become a vital modality for diagnosing lung transplant complications in children as well as assessing therapeutic responses. Herein, we review the value of flexible bronchoscopy in the management of children after lung transplant and discuss the application of novel techniques to improve care for this complex pediatric patient population and we provide a brief update about new diagnostic techniques applied in the growing lung transplantation field.

对于患有晚期肺病或肺血管疾病并被认为是合适人选的儿童来说，小儿肺移植是一种治疗选择。小儿柔性支气管镜是一个重要且不断发展的领域，与小儿肺移植人群高度相关。因此，提高我们的知识水平以更好地了解如何利用小儿支气管镜最大限度地优化肺移植术后儿童的护理非常重要。我们的目标是不断提高支气管镜检查的操作技能，降低并发症发生率，同时获取足够的样本进行诊断评估。实现这些目标至关重要，因为通过支气管镜活检对异体移植物进行评估是组织学诊断急性细胞排斥反应的必要条件，也是确定肺移植后常见并发症--慢性肺异体移植物功能障碍的重要因素。柔性支气管镜与支气管肺泡灌洗和经支气管肺活检在肺移植移植物评估中发挥着关键作用。在本文中，我们将讨论支气管镜在小儿肺移植评估中的应用，包括历史方法、我们的经验以及支气管镜和不断发展的小儿肺移植领域的未来方向。小儿柔性支气管镜已成为诊断儿童肺移植并发症和评估治疗反应的重要方式。在此，我们回顾了柔性支气管镜在儿童肺移植术后管理中的价值，讨论了如何应用新技术改善对这一复杂的儿科患者群体的护理，并简要介绍了在不断发展的肺移植领域应用的新诊断技术的最新情况。

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引用次数: 0

Evaluating threshold for donor fraction cell-free DNA using clinically available assay for rejection in pediatric and adult heart transplantation. 使用临床可用的检测方法评估小儿和成人心脏移植排斥反应中供体部分无细胞 DNA 的阈值。

IF 1.3 4区医学 Q3 PEDIATRICS

Pediatric Transplantation

Pub Date : 2024-05-01 DOI: 10.1111/petr.14708

Shriprasad R Deshpande, Steven D Zangwill, Marc E Richmond, Steven J Kindel, Jacob N Schroder, Nunzio Gaglianello, David P Bichell, Mark A Wigger, Kenneth R Knecht, Phillip T Thrush, William T Mahle, Paula E North, Pippa M Simpson, Liyun Zhang, Mahua Dasgupta, Aoy Tomita-Mitchell, Michael E Mitchell

Background: The aims of the study were to assess the performance of a clinically available cell-free DNA (cfDNA) assay in a large cohort of pediatric and adult heart transplant recipients and to evaluate performance at specific cut points in detection of rejection.

Methods: Observational, non-interventional, prospective study enrolled pediatric and adult heart transplant recipients from seven centers. Biopsy-associated plasma samples were used for cfDNA measurements. Pre-determined cut points were tested for analytic performance.

Results: A total of 487 samples from 160 subjects were used for the analysis. There were significant differences for df-cfDNA values between rejection [0.21% (IQR 0.12-0.69)] and healthy samples [0.05% (IQR 0.01-0.14), p < .0001]. The pediatric rejection group had a median df-cfDNA value of 0.93% (IQR 0.28-2.84) compared to 0.09% (IQR 0.04-0.23) for healthy samples, p = .005. Overall negative predictive value was 0.94 while it was 0.99 for pediatric patients. Cut points of 0.13% and 0.15% were tested for various types of rejection profiles and were appropriate to rule out rejection.

Conclusion: The study suggests that pediatric patients with rejection show higher levels of circulating df-cfDNA compared to adults and supports the specific cut points for clinical use in pediatric and adult patients with overall acceptable performance.

研究背景该研究的目的是评估临床上可用的无细胞DNA（cfDNA）测定在一大批儿童和成人心脏移植受者中的性能，并评估特定切点在检测排斥反应方面的性能：观察性、非干预性、前瞻性研究招募了来自七个中心的儿童和成人心脏移植受者。活检相关血浆样本用于 cfDNA 测量。对预先确定的切点进行了分析性能测试：共有来自 160 名受试者的 487 份样本被用于分析。排斥样本[0.21%（IQR 0.12-0.69）]和健康样本[0.05%（IQR 0.01-0.14），p]的 df-cfDNA 值存在明显差异：该研究表明，与成人相比，儿科排斥反应患者的循环 df-cfDNA 水平更高，并支持儿科和成人患者临床使用的特定切点，总体表现可接受。

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引用次数: 0

Optimizing the approach to monitoring allograft inflammation using serial urinary CXCL10/creatinine testing in pediatric kidney transplant recipients. 利用连续尿液CXCL10/肌酐检测优化监测小儿肾移植受者异体移植物炎症的方法。

IF 1.3 4区医学 Q3 PEDIATRICS

Pediatric Transplantation

Pub Date : 2024-05-01 DOI: 10.1111/petr.14718

Ella Barrett-Chan, Li Wang, Jeffrey Bone, Amy Thachil, Kevin Vytlingam, Tom Blydt-Hansen

Background: Urinary CXCL10/creatinine (uCXCL10/Cr) is proposed as an effective biomarker of subclinical rejection in pediatric kidney transplant recipients. This study objective was to model implementation in the clinical setting.

Methods: Banked urine samples at a single center were tested for uCXCL10/Cr to validate published thresholds for rejection diagnosis (>80% specificity). The positive predictive value (PPV) for rejection diagnosis for uCXCL10/Cr-indicated biopsy was modeled with first-positive versus two-test-positive approaches, with accounting for changes associated with urinary tract infection (UTI), BK and CMV viremia, and subsequent recovery.

Results: Seventy patients aged 10.5 ± 5.6 years at transplant (60% male) had n = 726 urine samples with n = 236 associated biopsies (no rejection = 167, borderline = 51, and Banff 1A = 18). A threshold of 12 ng/mmol was validated for Banff 1A versus no-rejection diagnosis (AUC = 0.74, 95% CI = 0.57-0.92). The first-positive test approach (n = 69) did not resolve a clinical diagnosis in 38 cases (55%), whereas the two-test approach resolved a clinical diagnosis in the majority as BK (n = 17/60, 28%), CMV (n = 4/60, 7%), UTI (n = 8/60, 13%), clinical rejection (n = 5/60, 8%), and transient elevation (n = 18, 30%). In those without a resolved clinical diagnosis, PPV from biopsy for subclinical rejection is 24% and 71% (p = .017), for first-test versus two-test models, respectively. After rejection treatment, uCXCL10/Cr level changes were all concordant with change in it-score. Sustained uCXCL10/Cr after CMV and BK viremia resolution was associated with later acute rejection.

Conclusions: Urinary CXCL10/Cr reliably identifies kidney allograft inflammation. These data support a two-test approach to reliably exclude other clinically identifiable sources of inflammation, for kidney biopsy indication to rule out subclinical rejection.

背景：尿液CXCL10/肌酐（uCXCL10/Cr）被认为是小儿肾移植受者亚临床排斥反应的有效生物标志物。本研究的目的是模拟在临床环境中的实施情况：方法：对一个中心的库存尿样进行uCXCL10/Cr检测，以验证已公布的排斥反应诊断阈值（特异性>80%）。结果：70 名年龄在 10.5 岁（含）以下的患者接受了uCXCL10/Cr检测：70名移植时年龄为（10.5 ± 5.6）岁的患者（60%为男性）共采集了n = 726份尿液样本和n = 236份相关活检样本（无排斥反应 = 167份、边缘 = 51份和Banff 1A = 18份）。班夫 1A 与无排斥诊断的阈值为 12 纳克/毫摩尔（AUC = 0.74，95% CI = 0.57-0.92）。首次阳性检测方法（n = 69）中有 38 例（55%）没有得到临床诊断，而两次检测方法中大多数人得到了临床诊断，分别是 BK（n = 17/60，28%）、CMV（n = 4/60，7%）、UTI（n = 8/60，13%）、临床排斥（n = 5/60，8%）和一过性升高（n = 18，30%）。在没有得到明确临床诊断的患者中，通过活检发现亚临床排斥反应的 PPV 在一测模型和二测模型中分别为 24% 和 71% (p = .017)。排斥治疗后，uCXCL10/Cr水平的变化与it评分的变化一致。CMV和BK病毒血症缓解后，持续的uCXCL10/Cr与后期急性排斥反应有关：结论：尿液中的 CXCL10/Cr 能可靠地识别肾脏移植物炎症。这些数据支持采用两种检测方法可靠地排除其他临床上可识别的炎症来源，以肾活检为指征排除亚临床排斥反应。

{"title":"Optimizing the approach to monitoring allograft inflammation using serial urinary CXCL10/creatinine testing in pediatric kidney transplant recipients.","authors":"Ella Barrett-Chan, Li Wang, Jeffrey Bone, Amy Thachil, Kevin Vytlingam, Tom Blydt-Hansen","doi":"10.1111/petr.14718","DOIUrl":"10.1111/petr.14718","url":null,"abstract":"Background: Urinary CXCL10/creatinine (uCXCL10/Cr) is proposed as an effective biomarker of subclinical rejection in pediatric kidney transplant recipients. This study objective was to model implementation in the clinical setting.Methods: Banked urine samples at a single center were tested for uCXCL10/Cr to validate published thresholds for rejection diagnosis (>80% specificity). The positive predictive value (PPV) for rejection diagnosis for uCXCL10/Cr-indicated biopsy was modeled with first-positive versus two-test-positive approaches, with accounting for changes associated with urinary tract infection (UTI), BK and CMV viremia, and subsequent recovery.Results: Seventy patients aged 10.5 ± 5.6 years at transplant (60% male) had n = 726 urine samples with n = 236 associated biopsies (no rejection = 167, borderline = 51, and Banff 1A = 18). A threshold of 12 ng/mmol was validated for Banff 1A versus no-rejection diagnosis (AUC = 0.74, 95% CI = 0.57-0.92). The first-positive test approach (n = 69) did not resolve a clinical diagnosis in 38 cases (55%), whereas the two-test approach resolved a clinical diagnosis in the majority as BK (n = 17/60, 28%), CMV (n = 4/60, 7%), UTI (n = 8/60, 13%), clinical rejection (n = 5/60, 8%), and transient elevation (n = 18, 30%). In those without a resolved clinical diagnosis, PPV from biopsy for subclinical rejection is 24% and 71% (p = .017), for first-test versus two-test models, respectively. After rejection treatment, uCXCL10/Cr level changes were all concordant with change in it-score. Sustained uCXCL10/Cr after CMV and BK viremia resolution was associated with later acute rejection.Conclusions: Urinary CXCL10/Cr reliably identifies kidney allograft inflammation. These data support a two-test approach to reliably exclude other clinically identifiable sources of inflammation, for kidney biopsy indication to rule out subclinical rejection.","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"28 3","pages":"e14718"},"PeriodicalIF":1.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140326968","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}

引用次数: 0

“Take it or leave it”: Analysis of pediatric heart offers for transplantation in Switzerland "要么接受，要么放弃瑞士小儿心脏移植申请分析

IF 1.3 4区医学 Q3 PEDIATRICS

Pediatric Transplantation

Pub Date : 2024-04-29 DOI: 10.1111/petr.14770

Stéphane Maire, Martin Schweiger, Franz Immer, René Prêtre, Stefano Di Bernardo, Alexander Kadner, Martin Glöckler, Christian Balmer

BackgroundThere is a shortage of donor hearts in Switzerland, especially for pediatric recipients. However, the rate and reason for refusals of pediatric donor hearts offered in Switzerland has not been systematically analyzed.MethodsThe national transplant database, Swiss Organ Allocation System, was searched for all hearts from Swiss and foreign donors younger than 16 years from 2015 to 2020. The numbers of accepted and refused hearts and early outcome were assessed, and the reasons for refusal were retrospectively analyzed.ResultsA total of 136 organs were offered to the three Swiss pediatric heart centers and foreign donor procurement organizations. Of these, 26/136 (19%) organs were accepted and transplanted: 18 hearts were transplanted in Switzerland, and 13 of these were foreign. Reasons for refusal were (1) no compatible recipient due to blood group or weight mismatch, 89.4%; (2) medical, meaning organ too marginal for transplantation, 7.4%; (3) logistic, 1.4%; and (4) other, 1.8%. Five organs were refused in Switzerland by one center but later accepted and successfully transplanted by another center. Hearts from outside Switzerland were transplanted significantly less than Swiss hearts (n = 16/120 vs. 10/16, p < .001).ConclusionThe most common reason for refusing a pediatric donor heart is lack of compatibility with the recipient. Few hearts are refused for medical reasons. A more generous acceptance seems to be justified in selected patients. Switzerland receives a high number of foreign offers, but their rate of acceptance is lower than that of Swiss donations.

背景瑞士缺乏供体心脏，尤其是用于儿童受体的供体心脏。方法在瑞士器官移植数据库 "瑞士器官分配系统 "中搜索了 2015 年至 2020 年间所有来自瑞士和外国的 16 岁以下捐献者的心脏。结果瑞士三家儿童心脏中心和国外捐献者采购组织共获得136个器官。其中，26/136（19%）个器官被接受并移植：18个心脏在瑞士移植，其中13个在国外。拒绝的原因有：(1) 血型或体重不匹配，没有匹配的受体，占 89.4%；(2) 医疗原因，即器官过于边缘化，不适合移植，占 7.4%；(3) 后勤原因，占 1.4%；(4) 其他原因，占 1.8%。有五个器官在瑞士被一个中心拒绝，但后来被另一个中心接受并成功移植。来自瑞士境外的心脏移植数量明显少于瑞士心脏（n = 16/120 vs. 10/16，p < .001）。因医学原因而拒绝捐献心脏的情况很少。对于选定的患者，似乎有理由更慷慨地接受捐赠。瑞士接受了大量的外国捐赠，但其接受率低于瑞士的捐赠率。

{"title":"“Take it or leave it”: Analysis of pediatric heart offers for transplantation in Switzerland","authors":"Stéphane Maire, Martin Schweiger, Franz Immer, René Prêtre, Stefano Di Bernardo, Alexander Kadner, Martin Glöckler, Christian Balmer","doi":"10.1111/petr.14770","DOIUrl":"https://doi.org/10.1111/petr.14770","url":null,"abstract":"BackgroundThere is a shortage of donor hearts in Switzerland, especially for pediatric recipients. However, the rate and reason for refusals of pediatric donor hearts offered in Switzerland has not been systematically analyzed.MethodsThe national transplant database, Swiss Organ Allocation System, was searched for all hearts from Swiss and foreign donors younger than 16 years from 2015 to 2020. The numbers of accepted and refused hearts and early outcome were assessed, and the reasons for refusal were retrospectively analyzed.ResultsA total of 136 organs were offered to the three Swiss pediatric heart centers and foreign donor procurement organizations. Of these, 26/136 (19%) organs were accepted and transplanted: 18 hearts were transplanted in Switzerland, and 13 of these were foreign. Reasons for refusal were (1) no compatible recipient due to blood group or weight mismatch, 89.4%; (2) medical, meaning organ too marginal for transplantation, 7.4%; (3) logistic, 1.4%; and (4) other, 1.8%. Five organs were refused in Switzerland by one center but later accepted and successfully transplanted by another center. Hearts from outside Switzerland were transplanted significantly less than Swiss hearts (n = 16/120 vs. 10/16, p < .001).ConclusionThe most common reason for refusing a pediatric donor heart is lack of compatibility with the recipient. Few hearts are refused for medical reasons. A more generous acceptance seems to be justified in selected patients. Switzerland receives a high number of foreign offers, but their rate of acceptance is lower than that of Swiss donations.","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"44 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140836803","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}

引用次数: 0

Pregnancy after transplant in the older adolescent: Anticipatory guidance for the pediatric provider 高龄青少年移植后怀孕：儿科医疗服务提供者的预期指导

IF 1.3 4区医学 Q3 PEDIATRICS

Pediatric Transplantation

Pub Date : 2024-04-29 DOI: 10.1111/petr.14752

Lisa A. Coscia, Dorothy Kliniewski, Serban Constantinescu, Michael J. Moritz

BackgroundHealthcare providers who care for adolescent and young adult transplant recipients should be aware of contraception counseling and potential for pregnancy in this at‐risk cohort.MethodsThis paper will review contraceptive options in general for transplant recipients. There will also be a review of common immunosuppressive medications and their risk profile regarding pregnancy after transplantation. Data from the Transplant Pregnancy Registry International were analyzed looking at recipients conceiving under the age of 21 and were compared to overall pregnancy outcomes.ResultsOverall pregnancy outcomes in recipients under the age of 21 are like the adult cohort.ConclusionIt is imperative to provide contraception counseling to the adolescent and young adult and inform their caregiver that pregnancy can happen if the recipient is sexually active. Pregnant adolescent and young adult transplant recipients should be followed by a multidisciplinary team to assure a positive outcome for the recipient, transplant, and neonate.

背景为青少年和年轻成人移植受者提供护理的医疗服务提供者应了解避孕咨询和这一高危人群怀孕的可能性。方法本文将综述移植受者的一般避孕选择。本文还将综述常见的免疫抑制药物及其与移植后怀孕有关的风险概况。对国际移植妊娠注册中心（Transplant Pregnancy Registry International）的数据进行了分析，观察 21 岁以下受者的受孕情况，并将其与总体妊娠结果进行比较。怀孕的青少年和年轻成人移植受者应接受多学科团队的随访，以确保受者、移植和新生儿都能获得积极的结果。

引用次数: 0

Adult and late adolescent complications of pediatric solid organ transplantation 小儿实体器官移植的成人和晚期青少年并发症

IF 1.3 4区医学 Q3 PEDIATRICS

Pediatric Transplantation

Pub Date : 2024-04-29 DOI: 10.1111/petr.14766

Connor J. Byeman, Lyndsay A. Harshman, Rachel M. Engen

BackgroundThere have been over 51 000 pediatric solid organ transplants since 1988 in the United States alone, leading to a growing population of long‐term survivors who face complications of childhood organ failure and long‐term immunosuppression.AimsThis is an educational review of existing literature.ResultsPediatric solid organ transplant recipients are at increased risk for risk for cardiovascular and kidney disease, skin cancers, and growth problems, though the severity of impact may vary by organ type. Pediatric recipients often are able to complete schooling, maintain a job, and form family and social networks in adulthood, though at somewhat lower rates than the general population, but face additional challenges related to neurocognitive deficits, mental health disorders, and discrimination.ConclusionsTransplant centers and research programs should expand their focus to include long‐term well‐being. Increased collaboration between pediatric and adult transplant specialists will be necessary to better understand and manage long‐term complications.

背景自1988年以来，仅在美国就有超过51,000例小儿实体器官移植，导致面临儿童器官衰竭并发症和长期免疫抑制的长期幸存者人数不断增加。结果小儿实体器官移植受者罹患心血管疾病、肾脏疾病、皮肤癌和生长问题的风险增加，但影响的严重程度可能因器官类型而异。小儿受者通常能够完成学业、维持工作，并在成年后组建家庭和社会网络，尽管比例略低于普通人群，但他们面临着与神经认知缺陷、心理健康障碍和歧视有关的额外挑战。为了更好地了解和管理长期并发症，有必要加强儿科和成人移植专家之间的合作。

引用次数: 0

Epstein–Barr virus‐associated post‐transplant lymphoproliferative disorders in pediatric transplantation: A prospective multicenter study in the United States 小儿移植中与爱泼斯坦-巴氏病毒相关的移植后淋巴组织增生性疾病：美国一项前瞻性多中心研究

IF 1.3 4区医学 Q3 PEDIATRICS

Pediatric Transplantation

Pub Date : 2024-04-29 DOI: 10.1111/petr.14763

Tetsuya Tajima, Olivia M. Martinez, Daniel Bernstein, Scott D. Boyd, Dita Gratzinger, Grant Lum, Kazunari Sasaki, Brent Tan, Clare J. Twist, Kenneth Weinberg, Brian Armstrong, Dev M. Desai, George V. Mazariegos, Clifford Chin, Thomas M. Fishbein, Akin Tekin, Robert S. Venick, Sheri M. Krams, Carlos O. Esquivel

BackgroundEpstein–Barr virus (EBV)‐associated post‐transplant lymphoproliferative disorders (PTLD) is the most common malignancy in children after transplant; however, difficulties for early detection may worsen the prognosis.MethodsThe prospective, multicenter, study enrolled 944 children (≤21 years of age). Of these, 872 received liver, heart, kidney, intestinal, or multivisceral transplants in seven US centers between 2014 and 2019 (NCT02182986). In total, 34 pediatric EBV+ PTLD (3.9%) were identified by biopsy. Variables included sex, age, race, ethnicity, transplanted organ, EBV viral load, pre‐transplant EBV serology, immunosuppression, response to chemotherapy and rituximab, and histopathological diagnosis.ResultsThe uni−/multivariable competing risk analyses revealed the combination of EBV‐seropositive donor and EBV‐naïve recipient (D+R−) was a significant risk factor for PTLD development (sub‐hazard ratio: 2.79 [1.34–5.78], p = .006) and EBV DNAemia (2.65 [1.72–4.09], p < .001). Patients with D+R− were significantly more associated with monomorphic/polymorphic PTLD than those with the other combinations (p = .02). Patients with monomorphic/polymorphic PTLD (n = 21) had significantly more EBV DNAemia than non‐PTLD patients (p < .001) and an earlier clinical presentation of PTLD than patients with hyperplasias (p < .001), within 6‐month post‐transplant. Among non‐liver transplant recipients, monomorphic/polymorphic PTLD were significantly more frequent than hyperplasias in patients ≥5 years of age at transplant (p = .01).ConclusionsD+R− is a risk factor for PTLD and EBV DNAemia and associated with the incidence of monomorphic/polymorphic PTLD. Intensive follow‐up of EBV viral load within 6‐month post‐transplant, especially for patients with D+R− and/or non‐liver transplant recipients ≥5 years of age at transplant, may help detect monomorphic/polymorphic PTLD early in pediatric transplant.

背景与爱泼斯坦-巴氏病毒（EBV）相关的移植后淋巴组织增生性疾病（PTLD）是儿童移植后最常见的恶性肿瘤；然而，早期检测困难可能会使预后恶化。其中872名儿童在2014年至2019年期间在美国的7个中心接受了肝脏、心脏、肾脏、肠道或多脏器移植（NCT02182986）。活检共发现34例小儿EBV+ PTLD（3.9%）。变量包括性别、年龄、种族、民族、移植器官、EBV病毒载量、移植前EBV血清学、免疫抑制、对化疗和利妥昔单抗的反应以及组织病理学诊断。结果单变量/多变量竞争风险分析显示，EBV血清学阳性供体和EBV未感染受体（D+R-）组合是PTLD发生（亚危险比：2.79 [1.34-5.78]，p = .006）和EBV DNA血症（2.65 [1.72-4.09]，p <.001）的重要风险因素。D+R-患者与单形/多形PTLD的相关性明显高于其他组合（p = .02）。单形/多形 PTLD 患者（n = 21）的 EBV DNA 血症明显多于非 PTLD 患者（p <.001），而且在移植后 6 个月内，PTLD 的临床表现早于增生患者（p <.001）。结论D+R-是PTLD和EBV DNA血症的危险因素，与单形/多形PTLD的发病率有关。移植后6个月内加强EBV病毒载量随访，尤其是对D+R-患者和/或移植时年龄≥5岁的非肝移植受者进行随访，有助于在儿科移植早期发现单形/多形性PTLD。

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引用次数: 0

Long‐term outcome of pediatric renal transplantation with donors younger than 6 years 小于 6 岁供体的儿科肾移植的长期结果

IF 1.3 4区医学 Q3 PEDIATRICS

Pediatric Transplantation

Pub Date : 2024-04-17 DOI: 10.1111/petr.14761

Carla Ramirez‐Amoros, Maria San Basilio, Virginia Amesty, Susana Rivas, Roberto Lobato, Carlota Fernandez‐Camblor, Pedro Lopez‐Pereira, Maria Jose Martinez‐Urrutia

BackgroundRenal transplantation is currently the best treatment option for patients with end‐stage renal disease. However, the use of kidneys from donors under 6 years of age as a possibility to increase the organ pool in pediatric recipients remains a controversial matter. We aimed to investigate whether donor age is associated to the long‐term functionality of the renal graft. Likewise, we analyzed the adaptation of the graft to the ascending functional requirements in the pediatric patient.MethodsRetrospective study of the results obtained in pediatric recipients transplanted with grafts from donors between 3 and 6 years of age, comparing them with those of grafts from donors older than 6 years. Among the variables compared are cumulative graft survival, renal size, need for antiproteinuric therapy, GFR, incidence of rejection, pyelonephritis, renal failure and surgical or tumor complications.ResultsA total of 43 transplants were performed with donors aged 3–6 years, and 42 transplants with donors older than 6 years. Cumulative graft survival at 5 years was 81% for the younger donor group compared to 98% for the older donor group (p < .05). At 8 years, cumulative graft survival for donors <6 years was 74%. As for the mean estimated graft survival, it was 11.52 years for the younger donor group and 14.51 years for older donors. During follow‐up, the younger donor group presented greater renal enlargement and need for antiproteinuric therapy. The older donors group had a higher GFR during the first year of follow‐up, which then equalized in both groups. There were no statistically significant differences in the incidence of acute or chronic rejection, acute pyelonephritis, acute renal failure or surgical or tumor complications.ConclusionsRenal transplants of grafts equal to or less than 6 years old have good short‐term and acceptable long‐term results in pediatric patients.

背景肾移植是目前治疗终末期肾病患者的最佳方法。然而，使用 6 岁以下捐献者的肾脏作为增加儿科受者器官库的一种可能性仍存在争议。我们的目的是研究供体年龄是否与肾脏移植的长期功能有关。方法对接受 3-6 岁供体移植的儿科受者的结果进行回顾性研究，并与接受 6 岁以上供体移植的结果进行比较。比较的变量包括累计移植物存活率、肾脏大小、抗蛋白尿治疗需求、肾小球滤过率、排斥反应发生率、肾盂肾炎、肾功能衰竭以及手术或肿瘤并发症。年龄较小的供体组 5 年的累积移植物存活率为 81%，而年龄较大的供体组为 98%（p <.05）。8 年时，6 岁捐献者的累计移植物存活率为 74%。至于平均估计移植物存活时间，年轻供体组为 11.52 年，年长供体组为 14.51 年。在随访期间，年轻供体组的肾脏肿大程度更高，需要进行抗蛋白尿治疗。老年捐献者组在随访的第一年中肾小球滤过率较高，随后两组的肾小球滤过率趋于一致。急性或慢性排斥反应、急性肾盂肾炎、急性肾功能衰竭、手术或肿瘤并发症的发生率在统计学上没有明显差异。

{"title":"Long‐term outcome of pediatric renal transplantation with donors younger than 6 years","authors":"Carla Ramirez‐Amoros, Maria San Basilio, Virginia Amesty, Susana Rivas, Roberto Lobato, Carlota Fernandez‐Camblor, Pedro Lopez‐Pereira, Maria Jose Martinez‐Urrutia","doi":"10.1111/petr.14761","DOIUrl":"https://doi.org/10.1111/petr.14761","url":null,"abstract":"BackgroundRenal transplantation is currently the best treatment option for patients with end‐stage renal disease. However, the use of kidneys from donors under 6 years of age as a possibility to increase the organ pool in pediatric recipients remains a controversial matter. We aimed to investigate whether donor age is associated to the long‐term functionality of the renal graft. Likewise, we analyzed the adaptation of the graft to the ascending functional requirements in the pediatric patient.MethodsRetrospective study of the results obtained in pediatric recipients transplanted with grafts from donors between 3 and 6 years of age, comparing them with those of grafts from donors older than 6 years. Among the variables compared are cumulative graft survival, renal size, need for antiproteinuric therapy, GFR, incidence of rejection, pyelonephritis, renal failure and surgical or tumor complications.ResultsA total of 43 transplants were performed with donors aged 3–6 years, and 42 transplants with donors older than 6 years. Cumulative graft survival at 5 years was 81% for the younger donor group compared to 98% for the older donor group (p < .05). At 8 years, cumulative graft survival for donors <6 years was 74%. As for the mean estimated graft survival, it was 11.52 years for the younger donor group and 14.51 years for older donors. During follow‐up, the younger donor group presented greater renal enlargement and need for antiproteinuric therapy. The older donors group had a higher GFR during the first year of follow‐up, which then equalized in both groups. There were no statistically significant differences in the incidence of acute or chronic rejection, acute pyelonephritis, acute renal failure or surgical or tumor complications.ConclusionsRenal transplants of grafts equal to or less than 6 years old have good short‐term and acceptable long‐term results in pediatric patients.","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"6 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140612659","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}

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