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Pediatric Transplantation

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https://read.qxmd.com/read/31012250/use-of-genetic-risks-in-pediatric-organ-transplantation-listing-decisions-a-national-survey
#1
Madeline Graf, Danton Char, Andrea Hanson-Kahn, David Magnus
There is a limited supply of organs for all those who need them for survival. Thus, careful decisions must be made about who is listed for transplant. Studies show that manifesting genetic disease can impact listing eligibility. What has not yet been studied is the impact genetic risks for future disease have on a patient's chance to be listed. Surveys were emailed to 163 pediatric liver, heart, and kidney transplant programs across the United States to elicit views and experiences of key clinicians regarding each program's use of genetic risks (ie, predispositions, positive predictive testing) in listing decisions...
April 23, 2019: Pediatric Transplantation
https://read.qxmd.com/read/31012242/low-dose-azacitidine-for-relapse-prevention-after-allogeneic-hematopoietic-cell-transplantation-in-children-with-myeloid-malignancies
#2
Benjamin R Oshrine, David Shyr, Gregory Hale, Aleksandra Petrovic
BACKGROUND: The prognosis of children who relapse after allogeneic hematopoietic cell transplant (alloHCT) for myeloid malignancies remains poor. PROCEDURE: To describe the safety and feasibility of post-transplant azacitidine for relapse prevention, we retrospectively reviewed the charts of 18 children undergoing alloHCT for myeloid malignancies. RESULTS: There were 15 evaluable patients since three patients did not receive planned azacitidine due to early relapse or TRM...
April 23, 2019: Pediatric Transplantation
https://read.qxmd.com/read/31012241/hepatic-artery-reconstruction-with-interposition-of-donor-s-right-gastroepiploic-artery-graft-in-pediatric-living-donor-liver-transplantation-for-metabolic-disease
#3
Xiaojie Chen, Lin Wei, Zhijun Zhu, Liying Sun, Wei Qu, Zhigui Zeng
OBJECTIVE: We introduce the indications, technique, results of our experience using donor's RGEA as interposition vessel to solve hepatic artery reconstruction problems in P-LDLT. METHODS: A retrospective analysis of P-LDLT for children with metabolic diseases from June 2013 to November 2018 in our center was carried out. The arterial conditions, reconstruction methods, and prognosis were analyzed. RESULTS: A total of 73 children with metabolic diseases underwent P-LDLT during the period...
April 23, 2019: Pediatric Transplantation
https://read.qxmd.com/read/31012231/successful-lung-donation-at-the-age-of-6-weeks-challenges-and-lessons-learned
#4
Evgeny Pavlushkov, Nagarajan Muthialu, Helen Spencer, Clair Ellis, Ben Davies, Sarah Claydon, Marius Berman
A clinical case of successful procurement and transplantation of bilateral lungs from 6-week-old infant with sepsis secondary to bacterial meningitis is reported. Forty-one-day-old male infant (height 60 cm, weight 4 kg) died of cerebral edema secondary to Escherichia coli meningitis and bacteremia. Preretrieval assessment included the following: arterial gases; pO2 50.4 kPa (378 mm Hg), pCO2 4.9 kPa (37 mm Hg), on FiO2 100%, PEEP 5 cm H2 O. Fiberoptic bronchoscopy showed no secretions nor mucosal inflammation; CXR revealed clear lung fields and pleural spaces...
April 23, 2019: Pediatric Transplantation
https://read.qxmd.com/read/31012220/antithrombotic-management-and-thrombosis-rates-in-children-post-liver-transplantation-a-case-series-and-literature-review
#5
Elise Flynn, Joanna Y Huang, Winita Hardikar, Lauren Herd, Alexandra Hodgson, Paul Monagle
Thrombosis is a major postoperative complication in pediatric liver transplantation. There is marked heterogeneity in prophylactic antithrombotic therapies used, without established guidelines. This review summarizes current worldwide incidence of thrombotic events and compares antithrombotic therapies in children post-liver transplant, with comparison to our institution's experience. Of the twenty-three articles with sufficient detail to compare antithrombotic regimens, the overall incidence of thrombosis ranged from 2...
April 23, 2019: Pediatric Transplantation
https://read.qxmd.com/read/31012212/high-dose-chemotherapy-with-autologous-stem-cell-transplantation-in-infants-and-young-children-with-ependymoma-a-10-year-experience-with-the-head-start-ii-protocol
#6
LETTER
Revathi Rajagopal, Jen Chun Foo, Vida Jawin, Ibrahim Qaddoumi, Eric Bouffet
No abstract text is available yet for this article.
April 23, 2019: Pediatric Transplantation
https://read.qxmd.com/read/31012209/sirolimus-associated-pericardial-effusion-with-cardiac-tamponade-and-interstitial-pneumonitis-in-a-hematopoietic-stem-cell-transplant-recipient
#7
Su Jin Joo, Inci Yildirim, Elizabeth O Stenger, Evan J Anderson
Sirolimus, a mammalian target of rapamycin (mTOR) inhibitor, is a potent immunosuppressant that is increasingly used in prevention and treatment of graft-vs-host disease (GVHD) in allogeneic hematopoietic stem cell transplant (HSCT) patients. However, data regarding its adverse effects in HSCT patients remain limited. We describe an 18-year-old HSCT patient with a history of invasive fungal infection, who developed pericardial effusion with cardiac tamponade and interstitial pneumonitis while receiving sirolimus for GVHD prophylaxis...
April 23, 2019: Pediatric Transplantation
https://read.qxmd.com/read/31012199/success-of-chemotherapy-and-a-liver-transplant-in-a-pediatric-patient-with-hepatic-angiosarcoma-a-case-report
#8
Kristy Pilbeam, Ben Eidenschink, Megan Sulciner, Mark Luquette, Joseph Neglia, Srinath Chinnakotla
Hepatic angiosarcoma is an extremely rare diagnosis in children, with fewer than 50 pediatric cases reported in the literature worldwide. This aggressive vascular sarcoma carries a very dismal prognosis and is known to be resistant to radiation, chemotherapy, and other vascular-targeted agents. Complete surgical resection is felt to provide the best chance for long-term survival. In patients with tumors not amenable to resection, a liver transplant can be considered. However, very few such transplants have been reported, given that they remain controversial due to high cancer recurrence and mortality post-transplant...
April 23, 2019: Pediatric Transplantation
https://read.qxmd.com/read/30983080/educational-needs-in-families-of-pediatric-liver-and-kidney-transplant-recipients-a-quality-improvement-project
#9
Katelin daCruz, Melissa K Cousino, Tanya Smith, Jacob Bilhartz, Sally J Eder, Emily M Fredericks
Parents of pediatric liver and kidney transplant recipients were surveyed regarding their current education plans (eg, Individualized Education Program, 504), satisfaction with these plans, and interest in educational support from the psychosocial transplant team. Survey results indicate high rates of IEP and 504 plans, academic and related services, and accommodations among this population. The majority of parents/guardians reported satisfaction with their child's current school plan and did not report need for additional transplant team support specific to school services on the survey measure...
April 14, 2019: Pediatric Transplantation
https://read.qxmd.com/read/30973673/plasma-electrolyte-imbalance-in-pediatric-kidney-transplant-recipients
#10
Wesley Hayes, Catherine Longley, Nicola Scanlon, William Bryant, Jelena Stojanovic, Nicos Kessaris, William Van't Hoff, Detlef Bockenhauer, Stephen D Marks
BACKGROUND: In current practice, pediatric kidney transplant recipients receive large volumes of intravenous fluid intraoperatively to establish allograft perfusion, and further fluid to replace urinary and insensible losses postoperatively. Acute electrolyte imbalance can result, with potential for neurological sequelae. We aimed to determine the incidence and severity of postoperative plasma electrolyte imbalance in pediatric kidney transplant recipients managed with the current standard intravenous crystalloid regimen...
April 11, 2019: Pediatric Transplantation
https://read.qxmd.com/read/30973671/kidney-disease-and-organ-transplantation-in-methylmalonic-acidaemia
#11
Damien Noone, Magdalena Riedl, Paul Atkison, Yaron Avitzur, Ajay P Sharma, Guido Filler, Komudi Siriwardena, Chitra Prasad
OBJECTIVES: MMA is associated with chronic tubulointerstitial nephritis and a progressive decline in GFR. Optimal management of these children is uncertain. Our objectives were to document the pre-, peri-, and post-transplant course of all children with MMA who underwent liver or combined liver-kidney transplant in our centers. DESIGN AND METHODS: Retrospective chart review of all cases of MMA who underwent organ transplantation over the last 10 years. RESULTS: Five children with MMA underwent liver transplant (4/5) and combined liver-kidney transplant (1/5)...
April 11, 2019: Pediatric Transplantation
https://read.qxmd.com/read/30973669/ofatumumab-in-post-transplantation-recurrence-of-focal-segmental-glomerulosclerosis-in-a-child
#12
Sonia Solomon, Anna Zolotnitskaya, Marcela Del Rio
FSGS is a potentially devastating form of nephrotic syndrome. Treatment of SRNS can be difficult, especially post-transplantation. The current therapy of post-transplant SRNS includes plasmapheresis, ACE-I, CNI, and monoclonal antibodies (rituximab). Patients who are refractory to these interventions have limited therapeutic alternatives. We present a case of a patient with SRNS secondary to FSGS. He did not respond to immunosuppressive medications prior to transplant, progressed to ESRD, and was started on chronic hemodialysis...
April 11, 2019: Pediatric Transplantation
https://read.qxmd.com/read/30973668/feasibility-of-extracorporeal-photopheresis-in-pediatric-patients-with-graft-versus-host-disease-after-hematopoietic-stem-cell-transplantation
#13
Signe Winther-Jørgensen, Marietta Nygaard, Carsten Heilmann, Marianne Ifversen, Kaspar Sørensen, Klaus Müller, Tania Masmas
Graft-versus-host disease (GVHD) is a main cause of morbidity and mortality following hematopoietic stem cell transplantation. The cumulative incidence of acute and chronic GVHD (aGVHD, cGVHD) reaches 30%-50% and 20% in pediatric populations, respectively. Prednisolone and/or calcineurin inhibitors (CNI) are first-line treatments, but no superior second-line treatment has yet been established. Several treatments have been suggested, among others extracorporeal photopheresis (ECP). Technical advances have made treatment of pediatric patients possible; however, only few reports on the feasibility of ECP in children have been published...
April 11, 2019: Pediatric Transplantation
https://read.qxmd.com/read/30973664/determination-of-risk-factors-affecting-mortality-in-patients-with-gastrointestinal-perforation-after-pediatric-liver-transplantation
#14
Bora Barut, Sami Akbulut, Koray Kutluturk, Cemalettin Koc, Dincer Ozgor, Cemalettin Aydin, Ayse Selimoglu, Sezai Yilmaz
Gastrointestinal perforation (GIP) is one of the most serious complications occurring after liver transplantation (LT), especially in pediatric patients. This study aimed to determine the risk factors affecting mortality in pediatric patients with GIP after LT. GIP developed in 37 (10%) of 370 pediatric patients who underwent LT at our institute. Patients were divided into two groups: alive (n = 22) or dead (n = 15), and both groups were compared in terms of demographic and clinical parameters using univariate analysis...
April 11, 2019: Pediatric Transplantation
https://read.qxmd.com/read/30973190/extracorporeal-membrane-oxygenation-use-in-the-first-24-hours-following-pediatric-heart-transplantation-incidence-risk-factors-and-outcomes
#15
Justin Godown, David W Bearl, Cary Thurm, Matt Hall, Brian Feingold, Jonathan H Soslow, Bret A Mettler, Andrew H Smith, Elizabeth L Profita, Tajinder P Singh, Debra A Dodd
Primary graft dysfunction following HTx is associated with significant morbidity and mortality. This study aimed to assess the incidence of, risk factors for, and outcomes of children requiring ECMO within 24 hours of HTx. This study utilized a linked PHIS/SRTR database of pediatric HTx recipients (2002-2016). Post-HTx ECMO was identified using inpatient billing data. Logistic regression assessed risk factors for post-HTx ECMO. Kaplan-Meier analyses assessed in-hospital mortality and post-discharge survival...
April 11, 2019: Pediatric Transplantation
https://read.qxmd.com/read/30955250/unrelated-donor-hematopoietic-stem-cell-transplantation-for-pediatric-de-novo-acute-myeloid-leukemia-with-intermediate-or-high-risk-cytogenetics
#16
Eu Gene Park, Eun Sang Yi, Young Bae Choi, Ki Woong Sung, Hong Hoe Koo, Keon Hee Yoo
The role of unrelated donor HSCT for children with de novo AML in CR1 is controversial. We performed this study to investigate the feasibility of unrelated donor HSCT who initially had intermediate- or high-risk cytogenetics. We retrospectively reviewed medical records of patients with AML who received unrelated HSCT in CR1 at Samsung Medical Center between November 2001 and January 2012. Patients were allocated based on karyotype at diagnosis as follows: (a) low-risk: inv(16), t(16;16), t(8;21), and t(15;17); (b) high-risk: -5, 5q-, -7, 3q abnormalities, t(8;16), t(6;9), t(6;11), t(6;21), t(10;11), complex karyotype (≥3 abnormalities), and acute megakaryocytic leukemia without t(1;22); and (c) IR: all the other karyotypes including normal...
April 6, 2019: Pediatric Transplantation
https://read.qxmd.com/read/30955249/strong-expression-of-p53-protein-in-bone-marrow-samples-after-hematopoietic-stem-cell-transplantation-indicates-risk-of-relapse-in-pediatric-acute-lymphoblastic-leukemia-patients
#17
Kristin Mattsson, Emma Honkaniemi, Kim Ramme, Gisela Barbany, Birgitta M Sander, Britt M Gustafsson
BACKGROUND: For pediatric ALL patients that relapse or respond poorly to conventional chemotherapy treatment, HSCT is one treatment option. Still, relapse occurs in 30% of the children after HSCT. Mutations in the tumor suppressor gene TP53 which can lead to an altered p53 protein expression are rare at time of diagnosis of ALL, yet occur more frequent at relapse indicating a more aggressive disease. Our aim was to evaluate if alterations in the expression of the tumor suppressor protein p53 signaled a relapse in pediatric ALL patients post-HSCT and could guide for preemptive immunotherapy...
April 6, 2019: Pediatric Transplantation
https://read.qxmd.com/read/30946509/use-of-a-donor-iliac-vein-graft-for-reconstruction-of-the-inferior-vena-cava-in-liver-transplantation-for-hepatoblastoma-with-caval-extension
#18
Amy Hort, Jonathan Karpelowsky, Albert Shun, Gordon Thomas
Complete microscopic tumor resection is critical for successful treatment of hepatoblastoma, and this may include when liver transplantation is required. For tumors involving the IVC or PV, complete resection should include the involved IVC or PV to ensure full tumor clearance. When this is required, the venous reconstruction at transplant or post-excision can be challenging. We present the management of an 18-month-old girl with PRETEXT Stage IV (P, V, F) hepatoblastoma and IVC involvement, where native caval resection and reconstruction was required...
April 4, 2019: Pediatric Transplantation
https://read.qxmd.com/read/30938071/renal-function-after-combined-liver-kidney-transplantation-a-longitudinal-study-of-pediatric-and-adult-patients
#19
Jesper M Kivelä, Marko Lempinen, Christer Holmberg, Hannu Jalanko, Mikko P Pakarinen, Helena Isoniemi, Jouni Lauronen
It has been proposed that the liver protects the kidney in CLKT. However, few studies have examined long-term renal function after CLKT and contrasted renal function of CLKT patients to KT patients beyond one year after transplantation. We studied long-term renal function of CLKT patients and compared renal function of CLKT patients to KT patients between one and five years after transplantation. Patients who underwent CLKT between 1993 and 2011 were included (n = 34; 11 children and 23 adults). Ninety-six (27 children and 69 adults) KT patients were selected as controls...
April 1, 2019: Pediatric Transplantation
https://read.qxmd.com/read/30932316/pressure-gradients-laboratory-changes-and-outcomes-with-transjugular-intrahepatic-portosystemic-shunts-in-pediatric-portal-hypertension
#20
Voytek Slowik, Eric J Monroe, Seth D Friedman, Evelyn K Hsu, Simon Horslen
INTRODUCTION: Indications for TIPS are well described in adults and involve complications of PHTN. Complications from PHTN are associated with PSG of > 12 mm Hg in adults. It is unclear if these parameters apply to children with PHTN. OBJECTIVE: To assess whether adult criteria for TIPS placement can be utilized in children, describe laboratory changes over time, and report outcomes. METHODS: We performed a retrospective review of 34 pediatric patients who underwent TIPS, examining indications, radiology, PSG reductions, laboratory changes, and outcomes...
April 1, 2019: Pediatric Transplantation
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