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Background: There is considerable variation in vaccination practices between pediatric transplant centers. This study aims to evaluate active immunization attitudes and practices among ERN‐TransplantChild centers and identify potential areas of improvement that could be addressed by shared evidence‐based protocols. Methods: A cross‐sectional questionnaire of attitudes and practices toward immunization of pediatric SOT and HSCT candidates and recipients was sent to a representative member of multidisciplinary teams from 27 European centers belonging to the ERN‐TransplantChild. Results: A total of 28/62 SOT programs and 6/12 HSCT programs across 21 European centers participated. A quarter of centers did not have an on‐site protocol for the immunizations. At the time of transplantation, pediatric candidates were fully immunized (80%–100%) in 57% and 33% of the SOT and HSCT programs. Variations in the time between vaccine administration and admission to the waiting list were reported between the centers, with 2 weeks for inactivated vaccines and variable time (2–4 weeks) for live‐attenuated vaccines (LAVs). Almost all sites recommended immunization in the post‐transplant period, with a time window of 4–8 months for the inactivated vaccines and 16–24 months for MMR and Varicella vaccines. Only five sites administer LAVs after transplantation, with seroconversion evaluated in 80% of cases. Conclusions: The immunization coverage of European pediatric transplant recipients is still inconsistent and far from adequate. This survey is a starting point for developing shared evidence‐based immunization protocols for safe vaccination among pediatric transplant centers and generating new research studies. [ABSTRACT FROM AUTHOR]

SOT recipients are more vulnerable to infections with antimicrobial‐resistant organisms, and therefore, it may be useful for transplant centers to create transplant‐specific antibiograms to direct empirical antimicrobial regimens and monitor trends in antimicrobial resistance. SOT‐specific antibiograms were created using antimicrobial susceptibility data on isolates from 2012 to 2018 at The Hospital for Sick Children, Toronto, Ontario, Canada. The CLSI guidelines were followed to generate the antibiograms except that results from 2 years of data were pooled on a rolling basis to achieve larger sample sizes. The 3 most frequent organisms in one analysis period of the SOT antibiogram were Escherichia coli (average sample size ±standard deviation; n = 28.7 ± 3.8), Staphylococcus aureus (n = 27.8 ± 5.0), and Pseudomonas aeruginosa (non‐CF) (n = 19.8 ± 8.8). For E.coli, susceptibilities in the SOT antibiogram were significantly lower than those in the hospital‐wide antibiogram in 2017–2018 for ampicillin (27% vs 47%; p =.014), piperacillin/tazobactam (55% vs 88%; p <.001), cefotaxime (59% vs 89%; p <.001), ciprofloxacin (71% vs 88%; p =.007), and trimethoprim‐sulfamethoxazole (41% vs 69%; p =.001), but not significantly different for aminoglycosides and meropenem. In the SOT antibiogram of E. coli, decreased susceptibility trend was confirmed in some antibiotics, including piperacillin/tazobactam (83% in 2012–2013 vs 55% in 2017–2018). At our center, the solid organ transplant–specific antibiogram revealed important differences in E. coli susceptibilities and trends in antimicrobial resistance. Developing a SOT antibiogram will assist in revising and improving empiric treatment guidelines as well as monitoring antimicrobial resistance in this population. [ABSTRACT FROM AUTHOR]

Background: Varicella and measles infections can be life‐threatening after solid organ transplantation (SOT) but may be preventable with live‐attenuated vaccines (LAV). Methods: This survey conducted in January 2019 among subscribers of the International Pediatric Transplantation Association listserv aimed to explore the current strategies to prevent and manage both infections in the pediatric SOT population, including recommending LAV after SOT. Results: The answers given by 95 pediatric SOT healthcare workers show that these strategies are not yet optimal and call for further education. In particular, 59% of respondents are unnecessarily waiting for a SOT candidate to be >1 year of age to start administrating LAV before SOT. Interestingly, most respondents are willing to administer LAV after SOT (57%), and a fifth (21%) are already doing so, off‐label. The survey queried the precautions taken to improve safety evaluations after LAV, and identified knowledge gaps and practitioners' concerns. Conclusion: The results of this survey could be used as a starting point for education and promotion of the safe administration of LAV in carefully selected SOT recipients; in turn, this would increase available data that would contribute to the development of evidence‐based guidelines by the transplant societies and ultimately prevent these infections after SOT. [ABSTRACT FROM AUTHOR]

Background: Low‐vaccination rates worldwide have led to the re‐emergence of vaccine‐preventable infections, including measles. Immunocompromised patients, including pediatric solid organ transplant (SOT) recipients, are at risk for measles because of suboptimal vaccination, reduced or waning vaccine immunity, lifelong immunosuppression, and global re‐emergence of measles. Objectives: To review published cases of measles in pediatric SOT recipients to heighten awareness of its clinical manifestations, summarize diagnostic and treatment strategies, and identify opportunities to optimize prevention. Methods: We conducted a literature review of published natural measles infections in SOT recipients ≤21 years of age, summarizing management and outcomes. We describe measles epidemiology, recommended diagnostics, treatment, and highlight prevention strategies. Results: There are seven published reports of measles infection in 12 pediatric SOT recipients, the majority of whom were unvaccinated or incompletely vaccinated. Subjects had atypical or severe clinical presentations, including lack of rash and complications, most frequently with encephalitis and pneumonitis, resulting in 33% mortality. Updated recommendations on testing and vaccination are provided. Treatment options beyond supportive care and vitamin A are limited, with no approved antivirals. Conclusion: While measles is infrequently reported in pediatric SOT recipients, morbidity and mortality remain significant. A high index of suspicion is warranted in susceptible SOT recipients with clinically compatible illness or exposure. Providers must recognize this risk, educate families, and be aware of both classic and atypical presentations of measles to rapidly identify, isolate, and diagnose measles in pediatric SOT recipients. Continued efforts to optimize measles vaccination both pre‐ and post‐SOT are warranted. [ABSTRACT FROM AUTHOR]

Malignancies are among the top three causes of patient death in pediatric and adult kidney transplant (KT) recipients. Solid organ transplant (SOT) recipients, including KT individuals, experience more cancer compared with the general population, including human papillomavirus (HPV)‐related anogenital and oropharyngeal cancers. This article describes the epidemiology, pathophysiology and natural history of the HPV infection in both the general population and in SOT recipients, as well as its role in the development of HPV‐related pre‐cancerous lesions and cancers. Emphasis is given to the primary prevention strategy, HPV vaccination in SOT recipients, and its particularities compared with the general population. Secondary prevention strategies in SOT recipients are discussed and compared with the general population, highlighting cervical cancer screening needs within SOT populations. The article emphasizes how these primary and secondary HPV prevention strategies applied during childhood and adolescence by the pediatric transplant professionals, can lower the burden of HPV‐related cancers for SOT recipients in subsequent years, during their adult life. [ABSTRACT FROM AUTHOR]

Background: The American Society of Transplantation in conjunction with the International Society for Heart and Lung Transplantation released a joint statement on August 13, 2021 in which they strongly recommend that solid organ transplant (SOT) recipients and their eligible household members and close contacts be vaccinated against SARS‐CoV‐2 with an approved COVID‐19 vaccine. Some SOT programs have gone further and will refuse to list or transplant candidates unless the candidate and their household are vaccinated against SARS‐CoV‐2. Methods: Two general pediatrician‐ethicists use current best evidence and moral theory to argue why it is unethical to mandate COVID‐19 vaccination for pediatric SOT candidates, their primary support person, and their households. Results: Pediatric vaccine mandates are most justifiable when they prevent the harm of a serious vaccine preventable disease (VPD) in children in settings where transmission is highly likely and there are no alternatives that are effective in preventing transmission that intrude less on individual freedom. An additional justification for a vaccine mandate in the SOT context is stewardship of a scarce resource if there is significant risk of graft loss from the VPD to an unvaccinated SOT candidate or recipient. Current evidence does not support fulfillment of these criteria in pediatric solid organ transplantation. Conclusions: Making SOT listing contingent on COVID‐19 vaccination is problematic. Though there is some risk of harm to a pediatric SOT candidate in remaining unvaccinated, the risk of harm of not being listed and transplanted is greater and overriding. [ABSTRACT FROM AUTHOR]

Background: The number of pediatric SOT recipients surviving into adulthood is increasing. Thus, understanding their psychosocial and QoL outcomes is important. We conducted a systematic review to collate existing literature examining QoL outcomes (physical functioning, psychological functioning, social functioning), as well as risk and protective factors associated with QoL, among adults who underwent SOT during childhood. Methods: A systematic search of five databases, from inception to January 6, 2021, was conducted to identify articles that reported on QoL outcomes for adults (≥18‐year of age) who received a SOT during childhood (<19‐year of age). Results: Twenty‐five articles met inclusion criteria. Studies examined QoL across a range of SOT populations (liver, kidney, heart). QoL and psychosocial outcomes were variable; however, the majority of studies indicated QoL in this population to be similar to the general population, or at least similar to other chronic illness groups, with the exception of physical and social functioning. Factors related to a more optimal medical course, younger age at transplant and follow‐up, and positive psychosocial functioning, were found to be predictive of better QoL outcomes. Conclusions: While several studies indicated QoL to be similar to the general population, the literature is limited in both quantity and quality. No study employed prospective, longitudinal methodologies to systematically evaluate QoL over time and few studies utilized normative‐based measures of QoL. Furthermore, several SOT groups were under‐represented in the literature (e.g., lung, intestine, multi‐visceral). Nonetheless, findings have implications for intervention and clinical decision‐making. [ABSTRACT FROM AUTHOR]

Background: COVID‐19 vaccination has been successful in decreasing rates of SARS‐CoV‐2 infection in areas with high vaccine uptake. Cases of breakthrough SARS‐CoV‐2 infection remain infrequent among immunocompetent vaccine recipients who are protected from severe COVID‐19. Robust data demonstrate the safety, immunogenicity, and effectiveness of several COVID‐19 vaccine formulations. Importantly, Pfizer‐BioNTech BNT162b2 mRNA COVID‐19 vaccine studies have now included children as young as 5 years of age with safety, immunogenicity, and effectiveness data publicly available. In the United States, emergency use authorization by the Federal Drug Administration and approval from the Centers for Disease Control/Advisory Committee on Immunization Practices have been provided for the 5‐ to 11‐year‐old age group. Methods: Members of the International Pediatric Transplant Association (IPTA) provide an updated review of current COVID‐19 vaccine data with focus on pediatric solid organ transplant (SOT)‐specific issues. Results: This review provides an overview of current COVID‐19 immunogenicity, safety, and efficacy data from key studies, with focus on data of importance to pediatric SOT recipients. Continued paucity of data in the setting of pediatric transplantation remains a challenge. Conclusions: Further studies of COVID‐19 vaccination in pediatric SOT recipients are needed to better understand post‐vaccine COVID‐19 T‐cell and antibody kinetics and determine the optimal vaccine schedule. Increased COVID‐19 vaccine acceptability, uptake, and worldwide availability are needed to limit the risk that COVID‐19 poses to pediatric solid organ transplant recipients. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic has proven to be a challenge in regard to the clinical presentation, prevention, diagnosis, and management of SARS‐CoV‐2 infection among children who are candidates for and recipients of SOT. By providing scenarios and frequently asked questions encountered in routine clinical practice, this document provides expert opinion and summarizes the available data regarding the prevention, diagnosis, and management of SARS‐CoV‐2 infection among pediatric SOT candidates and recipients and highlights ongoing knowledge gaps requiring further study. Currently available data are still lacking in the pediatric SOT population, but data have emerged in both the adult SOT and general pediatric population regarding the approach to COVID‐19. The document provides expert opinion regarding prevention, diagnosis, and management of SARS‐CoV‐2 infection among pediatric SOT candidates and recipients. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal symptoms are common among solid organ transplant (SOT) recipients. Information about colonoscopy findings after pediatric SOT is limited. This retrospective study reports endoscopy findings in a nationwide pediatric transplant recipient cohort. Methods: All pediatric recipients (kidney, liver, or heart) transplanted between 2010 and 2020 at our institution (n = 193) who had undergone ileocolonoscopy and upper gastrointestinal endoscopy after SOT were enrolled. Sixteen patients were identified. A meticulous search on clinical data including transplantation, gastrointestinal symptoms, endoscopy findings, and follow‐up data was performed. Results: Endoscopy was performed at a median of 2.6 years (0.4–13.3) after the first transplantation (median age at SOT 1.2 years). Gastrointestinal symptoms leading to endoscopy did not differ between the different transplant groups. The leading endoscopy indications were prolonged diarrhea and anemia. PTLD was found in 8 (50%) patients. Five were histologically early PTLD lesions and three were monomorphic large B‐cell PTLDs (two EBV‐positive and one EBV‐negative), one having previously been diagnosed with autoimmune enteropathy. One patient had EBV enteritis. De novo inflammatory bowel disease was found in one patient, eosinophilic gastroenteritis in another, and in one patient with several episodes of watery diarrhea, the histological finding was mild non‐specific colitis. In four patients, the endoscopy finding remained unclear and the symptoms were suspected to be caused by infectious agents or mycophenolate. Conclusions: PTDL with various stages is a common finding after pediatric SOT in patients with gastrointestinal symptoms. Endoscopy should be considered in transplant recipients with prolonged diarrhea, anemia, and/or abdominal pain. [ABSTRACT FROM AUTHOR]

Background: Population‐level COVID‐19 immunization will play a key role in slowing down the SARS‐CoV‐2 pandemic on a global scale and protect the most at‐risk individuals. Thanks to a formidable universal effort, several SARS‐CoV‐2 vaccines have been marketed less than a year since the first documented COVID‐19 case, with promising safety, efficacy, and immunogenicity results in adults. As children were not included in the initial trials, no vaccine is currently approved for individuals <16 years of age. Similarly, immunosuppressed individuals, such as solid organ transplant recipients, were excluded from initial vaccine trials, limiting the understanding of vaccine immunogenicity and safety in this at‐risk population. Thus, data regarding COVID‐19 vaccination in pediatric solid organ transplantation recipients are currently lacking. Methods: Members of the International Pediatric Transplant Association review the current general status of COVID‐19 vaccines focusing on pediatric‐specific issues. Results: This review provides an overview of COVID‐19 vaccines in pediatric SOT recipients and highlights the current paucity of data in both pediatric and transplant settings in terms of safety, immunogenicity, and clinical efficacy. Conclusions: Vaccine trials including children and transplant recipients are underway and will be necessary to characterize COVID‐19 vaccine safety, immunogenicity, and efficacy, which will determine potential future research directions. [ABSTRACT FROM AUTHOR]

Background: Adult SOT recipients with COVID‐19 have higher mortality rates when compared to general population. There is paucity of data on outcomes in pediatric SOT recipients. Methods: This is a cross‐sectional study investigating the prevalence of COVID‐19 infection and outcomes in pediatric SOT (heart, liver, and kidney) recipients. We extracted demographic and clinical characteristics and COVID‐19 testing (PCR or [Ab] test) results from medical records. Clinical characteristics were compared between patients who were positive for COVID‐19 (PCR or Ab) and those who did not, using Mann‐Whitney, Student's t test, or chi‐square test. p value <.05 was statistically significant. Results: A total of 108 SOT recipients with a median age of 13.1 (8.4, 17.8) years and median 4.2 (2.7, 7.9) years from transplant were checked for COVID‐19 via a PCR or Ab test. A positive PCR was confirmed in 10 patients (9.3%), while 12 patients (11.1%) were positive for COVID‐19 Ab. The patients who tested positive in our cohort were 9/50 (18%) heart, 6/68 (8.8%) kidney, and 7/50 (14%) liver transplant recipients. There were no differences in the clinical characteristics between patients with and without COVID‐19 infection. All patients were either asymptomatic (50%) or had self‐limiting symptoms. No changes were made to the immunosuppressive regimen. Only one patient was hospitalized and none had an oxygen requirement. Conclusions: In our cohort of pediatric SOT recipients, COVID‐19 infection was asymptomatic or mild. This data may aid clinicians in counseling patients and families in this increased‐risk population. [ABSTRACT FROM AUTHOR]

Background: Reliable methods to detect and reduce medication nonadherence in solid organ‐transplanted (SOT) adolescents are warranted. We aimed to evaluate the feasibility of combining a medication‐manager application (TusenTac®‐app) with home‐sampling of tacrolimus (Tac) in young SOT recipients. Methods: Kidney and combined SOT recipients between 14 and 25 years were included. During an 8‐week intervention period, the participants were instructed to use the transplant‐specific, age‐adapted TusenTac®‐app daily and to perform weekly at‐home Tac trough finger‐prick microsampling. Microsample Tac concentrations were controlled against timed venous samples twice. Medication implementation and persistence adherence were measured with BAASIS© questionnaires, TusenTac®‐registrations, Tac trough concentration coefficient of variation (CV%) and self‐reporting by interview. For comparison, venous Tac trough CV% were obtained from the year before and after the short‐term intervention. Results: Twenty‐two recipients were included, two withdrawals, leaving 20; median age 17.9 (14.5–24.8) years, 12 females (60%). The participants registered their dosage intake 88% (1502/1703) of the expected times, and 90% (106/118) of the microsamples were obtained correctly. At inclusion, 11 recipients (55%) were nonadherent assessed with BAASIS© questionnaire, four of these (36%) turned adherent during the intervention period. At the end, 70% reported improved timing‐adherence at the interview. There was no significant change in TacCV% from the year before to the year after the short‐term intervention. Home‐sampling was reliable and measured Tac concentrations accurately. Conclusions: Home‐monitoring, combining Tac finger‐prick microsampling and a medication‐manager app, is feasible in adolescent SOT recipients with 70% perceived improvement in medication timing‐adherence. There were no significant long‐term changes in TacCV% confirming the need for continuous use and individualized interventions. [ABSTRACT FROM AUTHOR]

Background: Cytomegalovirus (CMV) is an important cause of morbidity and mortality in pediatric solid organ transplant (SOT) recipients. However, the impact of asymptomatic CMV infections (ie, DNAemia) on clinical outcomes is not well established. Methods: We performed a retrospective cohort study of children undergoing first SOT at our institution from January 2012 to June 2018. We evaluated the epidemiology of CMV infections and performed multivariable Cox regression to assess the association between CMV DNAemia without disease or CMV disease (syndrome or end‐organ disease) on negative outcomes (death, re‐transplantation, or moderate/severe rejection) within the first year after SOT. Results: Among 271 individuals, 43 (15.9%) developed ≥1 CMV infection during the first year after SOT. There were 56 unique CMV infections including 14 episodes of CMV disease. In 167 patients offered CMV prophylaxis, only 8 (4.8%) developed their first CMV DNAemia episode while on prophylaxis 32 developed CMV DNAemia after prophylaxis completion; only 1 episode of CMV disease occurred while on antiviral prophylaxis. When accounting for receipt of ATG, oral steroids, and number of immunosuppressives on a given day, CMV disease was more strongly associated with negative outcomes (Hazard Ratio (HR): 3.28, 95% CI: 0.73–14.64; p =.12) than CMV DNAemia without disease (HR 1.42, 95% CI: 0.19– 10.79; p =.74), although not to a statistically significant degree. Conclusions: Most CMV infections occurred after completion of antiviral prophylaxis. CMV disease was more strongly associated with negative outcomes than asymptomatic CMV DNAemia and should be the focus of CMV prevention practices. [ABSTRACT FROM AUTHOR]

Background: Facilitating communication between adolescents and HCP outside of appointments may enhance patient experience and outcomes. The purpose of this study was to determine whether SMS enhances the healthcare experience, QoL, and medication adherence in adolescent SOT patients. Methods: This was a prospective observational study of an SMS platform (WelTel Inc) for SOT patients aged 12–19 years. QoL was assessed before and after using the PedsQL™ Transplant Module. Medication adherence was assessed with the frequency of therapeutic tacrolimus levels and variation based on control chart analysis. Patient experience and engagement was evaluated with surveys, response rate to messages, and number of clinical conversations (>2 messages). Results: Twenty‐three patients were included (median age 15.7 years (IQR 13.6–17.1)). Median intervention duration was 13.5 months (range 4.0–16.7 months). There was a 68% response rate (742/1095) with 375 clinical conversations. The majority of patients reported the intervention provided a positive outlook on their health (17/23), was useful (18/23), and improved their connection to HCPs (17/23). Following the intervention, there was no significant difference in the median scaled QoL scores (pre‐intervention: 81 (IQR 76.5–93.3), post‐intervention: 78 (IQR 76–93); p =.37), mean percentage of therapeutic tacrolimus levels (pre‐intervention: 52 ± 25%, post‐intervention: 65 ± 17%; p =.07), or variation on control chart analysis of tacrolimus levels. Conclusions: The WelTel messaging platform provided supplemental clinical care for a group of adolescent SOT patients that enhanced their healthcare experience. Patient QoL and adherence were unchanged following the intervention and remained at a high level. [ABSTRACT FROM AUTHOR]

Use of sodium-glucose co-transporter 2 inhibitors in solid organ transplant recipients with pre-existing type 2 or post-transplantation diabetes mellitus: a systematic review. The ongoing need to improve long-term patient survival of pediatric solid organ recipients Abbreviations CNS congenital nephrotic syndrome MRI magnetic resonance imaging PTLD post-transplant lymphoproliferative disease SGLT2i sodium-glucose cotransporter 2 inhibitors SOT Solid organ transplantation INTRODUCTION Solid organ transplantation (SOT) is the therapy of choice for end-stage organ disease in children and adolescents. Salonen et al.[6] reported survival of all pediatric SOT recipients (kidney, liver and heart) in Finland. [Extracted from the article]

Keywords: children; everolimus; solid organ transplantation EN children everolimus solid organ transplantation 1 3 3 02/13/23 20230301 NES 230301 Abbreviations IgG immunoglobulin G MMR measles-mumps-rubella SOT solid organ transplantation INTRODUCTION In childhood, some vaccines may not be administered before solid organ transplantation (SOT) due to the age at the time of planned surgery, clinical status, and the lack of sufficient time between transplantation and vaccination.[1] Although there was indecisiveness about the attenuated live vaccine administration to children after SOT, current studies and consensus recommendations reported that it can be administered in selected cases.[[2]] Here, attenuated live vaccine administration is described in two cases who had to use everolimus instead of tacrolimus after SOT. It was noticed that the varicella vaccine had not been administered, and she tested negative for varicella IgG. [Extracted from the article]

Solid organ transplantation (SOT) is the gold standard of therapy for individuals with end‐organ dysfunction. Improved survival outcomes after SOT can help adolescent and young adult (AYA) recipients lead long and healthy life. However, successful SOT during adolescence and young adulthood is often complicated by the innate developmental challenges of this age group. The psychosocial tasks of adolescence include identity development, autonomous decision‐making, establishing social networks, educational and vocational preparation, and navigating romantic relationships. These goals may be amplified or delayed for pediatric SOT recipients. Adolescence is also marked by rapid physical changes in linear growth and the development of secondary sexual characteristics. Yet AYA may experience physical and pubertal delays related to transplantation, as well as exaggerated body image dissatisfaction due to medication side effects. Strict adherence to medication and post‐transplant regimens may interfere with adolescents' desire for normalcy and fitting in with peers. Healthcare providers should be aware that AYA value education and self‐empowerment in transplant care. Transplant success needs to be defined by both medical and psychosocial outcomes, particularly when it relates to the vulnerable AYA population. Fortunately, investment from the patient, family, and care team can aid in transplant recovery and success. This article will identify the developmental challenges faced by AYA undergoing solid organ transplantation as well as strategies to engage positive outcomes. [ABSTRACT FROM AUTHOR]

Background: Life with end‐stage organ failure is accompanied by an accumulation of traumatic medical or surgical experiences. Despite recovery after solid organ transplantation (SOT), many children and adolescents develop post‐traumatic stress symptoms (PTSS). PTSS remain underappreciated as a major comorbidity in SOT programs, despite their association with decreased quality of life. Methods: We conducted a retrospective, cross‐sectional study of 86 pediatric SOT recipients (17 heart, 44 kidney, and 25 liver) to evaluate potential determinants of PTSS. Trauma symptoms were measured by the Child Trauma Screening Questionnaire (CTSQ). Demographic, baseline, and contemporaneous factors were tested for independent association with CTSQ scores. Results: The median post‐transplant CTSQ score was 2 (IQR 1–4), and 22% were identified as high risk (score ≥5) for PTSD. Higher CTSQ scores were independently associated with the number of ICU days within the previous 12 months, the number of medications (complexity), and involvement with foster care in the primary model (R2 [adj.] = 0.26). The addition of the Family Impact Module improved the overall model (R2 [adj.] = 0.33), wherein higher family functioning was independently associated with lower CTSQ scores. An exploratory analysis of pre‐transplant patients (n = 34) found a median pre‐transplant CTSQ of 2 (IQR 1–6), suggesting that PTSS are onset before transplant and persist afterward. Conclusions: PTSS are highly prevalent in the SOT population. Risk factors include recent adverse medical experiences and complexity, whereas family stability may be protective. Additional research is needed to improve early ascertainment and support for patients at high risk of developing PTSS throughout their transplant journey. [ABSTRACT FROM AUTHOR]

Diarrhea in the pediatric solid organ transplantation (SOT) recipient is a frequent complaint that is associated with significant morbidity and impaired quality of life. There are limited published data regarding the specific epidemiology, diagnostic evaluation, and treatment of diarrhea after SOT in children. Pediatric SOT recipients have an increased risk of developing diarrhea because of a generalized immunosuppressed state, epidemiologic exposures, and polypharmacy. There is a need to standardize the diagnostic evaluation of diarrhea in children after SOT to facilitate an accurate diagnosis and timely treatment. Herein, we review the available published data and propose a systematic, stepwise approach to the evaluation of diarrhea in this high‐risk population, focusing on timely diagnosis of both infectious and non‐infectious causes, in order to provide focused management. Prospective studies are needed to better assess the true prevalence, risk factors for, etiologies, and complications of diarrhea in pediatric SOT patients that will guide optimal management. Development of effective vaccines and antiviral therapies for enteric viruses may also contribute to improved outcomes. [ABSTRACT FROM AUTHOR]

The majority of Americans make their sexual debut during their adolescent years. Preventing pregnancy and STI during this period is vital to ensuring health and safety. As survival has improved after pediatric SOT, chronically immunosuppressed adolescents seek guidance in their medical home on matters of sexual health. Transplant practitioners often do not feel equipped to fully address these needs. This review serves as an introductory sexual preventive care resource for adolescent and young adult (AYA) SOT recipients. First, we review data on safety, efficacy, and use of contraceptive options currently available for transplant recipients with child‐bearing potential. Then, we suggest a personalized sexual health discussion focusing on the diagnosis and prevention of STIs in adolescent and young adult transplant recipients. Finally, we present recommendations for STI screening of asymptomatic patients, use of index of suspicion and diagnostic testing in symptomatic patients, and opportunities to optimize STI prevention strategies. Data compiled from studies of adult SOT recipients, general population studies, and published guidelines are often extrapolated for use, as limited data exist in AYA SOT recipients. This informational dearth underscores the need for future research to better characterize the unique needs of AYA SOT recipients. [ABSTRACT FROM AUTHOR]

SOT recipients are at high risk for developing severe infectious complications following discharge from the hospital. Comprehensive anticipatory guidance surrounding everyday lifestyle choices can potentially prevent exposure to infectious agents from the environment. This paper reviews the risks that pediatric and adolescent SOT recipients encounter through exposures such as household contacts, outdoor activities, travel, animal exposures, and dietary choices. Although strong evidence is lacking, this paper makes recommendations aimed at minimizing the risk of infectious complications and hospitalization in pediatric SOT recipients. [ABSTRACT FROM AUTHOR]

Background: COVID‐19 vaccine is recommended for individuals ages ≥6 months; however, whether vaccination should be mandated for transplant candidates and living donors remains controversial. This study assessed COVID‐19 policies at US pediatric solid organ transplant centers. Methods: A 79‐item survey was emailed between March and April 2022 to 200 UNOS Medical Directors detailing center COVID‐19 vaccine policies for transplant candidates and living donors and use of grafts from COVID‐19‐positive deceased donors. Results: The response rate was 77% (154/200). For children aged 5–15 years, 23% (35/154 centers) have a COVID‐19 vaccine mandate, 27% (42/154) anticipate implementing a future mandate, and 47% (72/154) have not considered or do not anticipate implementing a mandate. For children ≥16 years, 32% (50/154 centers) have a COVID‐19 vaccine mandate, 25% (39/154) anticipate implementing a future mandate, and 40% (62/154) have not considered or do not anticipate implementing a mandate. The top two reasons for not implementing a COVID‐19 vaccine mandate were concerns about penalizing a child for their parent's decision and worsening inequities in transplant. Of 85 kidney and liver living donor centers, 32% (27/85) require vaccination of donors. Twenty percent (31/154) of centers accept organs from COVID‐19‐positive deceased donors. Conclusions: There is great variation among pediatric SOT centers in both the implementation and details of COVID‐19 vaccine mandates for candidates and living donors. To guide more uniform policies, further data are needed on COVID‐19 disease, vaccine efficacy, and use of grafts from donors positive for COVID‐19 in the pediatric transplant population. [ABSTRACT FROM AUTHOR]

HAdV viremia can cause significant morbidity among pediatric recipients of SOT with variability in incidence and severity of disease based on the type of allograft. Currently, there are no US FDA-approved treatments for HAdV infections, and historically, the mainstay of treatment has been decreasing immunosuppression, with antiviral therapies reserved for those with severe disease. We describe the treatment of four pediatric SOT recipients (two kidney, one combined kidney-liver, and one liver) presenting with HAdV disease at our institution using brincidofovir. Our case series highlights the variability in presentation and the potential for severe disease in pediatric SOT recipients as we review disease presentation, disease course, complications, and treatment with brincidofovir. [ABSTRACT FROM AUTHOR]

Background: Post‐traumatic stress symptoms (PTSS) have been reported by pediatric solid organ transplant (SOT) patients and their caregivers well after transplantation. This study examined the relationship between PTSS, medication adherence, and medical complications in SOT patients and their caregivers. A secondary aim examined the association between patient and caregiver‐reported PTSS. Methods: Pediatric SOT patients (N = 69) and caregivers (N = 73) reported on PTSS by completing the Child PTSD Symptom Scale (patients 8–17 years) or the Impact of Events Scale—Revised (patients 18 years and older and caregivers). Patient medication adherence was assessed using the Medication Level Variability Index (MLVI). Patients were dichotomized as experiencing a post‐transplant medical complication (ie, transplant‐related hospital admission prior to the year completing measures of PTSS) or no complications. Results: Medication adherence was not significantly associated with patient or caregiver PTSS. A moderate effect size was found for elevated young adult and caregiver PTSS and the presence of a medical complication. Generally, the association between self‐reported patient and caregiver PTSS was low. Conclusions: The presence of elevated PTSS in young adult patients may be partially explained by the presence of proximal medical complications and more so by comorbid psychiatric diagnoses in child and adolescent patients (based on exploratory analyses). Caregivers of patients with medical complications within the past year reported higher levels of PTSS. Overall, transplantation and its associated impact on PTSS may be unique experience for patients versus caregivers. Qualitative research may further elucidate these experiences and inform future clinical interventions. [ABSTRACT FROM AUTHOR]

Background: The SARS‐CoV‐2 pandemic and corresponding acute respiratory syndrome have affected all populations and led to millions of deaths worldwide. The pandemic disproportionately affected immunocompromised and immunosuppressed adult patients who had received solid organ transplants (SOTs). With the onset of the pandemic, transplant societies across the world recommended reducing SOT activities to avoid exposing immunosuppressed recipients. Due to the risk of COVID‐19‐related outcomes, SOT providers adapted the way they deliver care to their patients, leading to a reliance on telehealth. Telehealth has helped organ transplant programs continue treatment regimens while protecting patients and physicians from COVID‐19 transmission. This review highlights the adverse effects of COVID‐19 on transplant activities and summarizes the increased role of telehealth in the management of solid organ transplant recipients (SOTRs) in both pediatric and adult populations. Methods: A comprehensive systematic review and meta‐analysis were conducted to accentuate the outcomes of COVID‐19 and analyze the efficacy of telehealth on transplant activities. This in‐depth examination summarizes extensive data on the clinical detriments of COVID‐19 in transplant recipients, advantages, disadvantages, patient/physician perspectives, and effectiveness in transplant treatment plans via telehealth. Results: COVID‐19 has caused an increase in mortality, morbidity, hospitalization, and ICU admission in SOTRs. Telehealth efficacy and benefits to both patients and physicians have increasingly been reported. Conclusions: Developing effective systems of telehealth delivery has become a top priority for healthcare providers during the COVID‐19 pandemic. Further research is necessary to validate the effectiveness of telehealth in other settings. [ABSTRACT FROM AUTHOR]

Background: An increasing number of pediatric solid organ transplant (SOT) recipients are surviving into adolescence and young adulthood. The transition from pediatric to adult‐oriented care occurs during a unique and vulnerable period. Methods: Presented here is a structured approach to healthcare transition (HCT) for adolescent and young adult SOT recipients aimed at optimizing independence in order to assist young patients with adherence, self‐management, and improved quality of life. Results: Close attention must be paid to neurocognitive development, mental well‐being, and social determinants of health. Conclusions: These efforts require a multidisciplinary team approach as well as collaboration between pediatric and adult providers in order to achieve these goals and patient longevity. [ABSTRACT FROM AUTHOR]

Background: Varicella‐zoster virus (VZV) pretransplant immunization rates, exposures, and posttransplant disease are poorly characterized among pediatric solid organ transplant (SOT) recipients in the two‐dose varicella vaccine era. Methods: A retrospective analysis of the electronic health records among children <18 years old who received SOT from January 1, 2011 through December 31, 2021, was performed at a single center to assess for missed pretransplant varicella vaccination opportunities, characterize VZV exposures, and describe posttransplant disease. Results: Among 525 children, 444 were ≥6 months old (m.o.) at SOT with a documented VZV vaccine status. Eighty‐five (19%) did not receive VZV Dose One; 30 out of 85 (35%) could have been immunized. Infants 6–11 m.o. accounted for 14 out of 30 (47%) missed opportunities. Among children ≥12 m.o. with documented Dose Two status (n = 383), 72 had missed vaccination opportunities; 57 out of 72 (79%) were children 1–4 years old. Most children had unclassifiable pre‐SOT serostatus as varicella serology was either not obtained/documented (n = 171) or the possibility of passive antibodies was not excluded (n = 137). Of those with classified serology (n = 188), 69 were seroimmune. Forty‐seven of 525 (9%) children had recorded VZV exposures; two developed varicella—neither had documented pre‐SOT seroimmunity nor had received post‐exposure prophylaxis. Nine additional children had medically attended disease: four primary varicella and five zoster. Of the 11 cases, 10 had cutaneous lesions without invasive disease; one had multi‐dermatomal zoster with transaminitis. Seven (64%) received treatment exclusively outpatient. Conclusions: VZV exposure and disease still occur. Optimizing immunization among eligible candidates and ensuring patients have a defined VZV serostatus pretransplantation remain goals of care. [ABSTRACT FROM AUTHOR]

AIHA is rare in the general population and associated with a mortality of 8%. In contrast, AIHA occurs in up to 12.2% of cases after intestinal transplantation and is associated with mortality up to 50%. Treatment entails a "step‐up" approach including corticosteroids, IvIg, plasmapheresis, and rituximab. However, AIHA after transplantation often is refractory to this strategy, contributing to a poor outcome. We describe a child with microvillous inclusion disease who developed AIHA 1 year after multivisceral transplantation that was refractory to standard therapy and was subsequently treated with bortezomib.We observed remission of AIHA within 1 week after the start of bortezomib. Bortezomib was associated with transient diarrhea, leucopenia, and elevated liver enzymes. Three years later, he remains in remission without important complications. Published data on bortezomib for autoimmune cytopenias outside SOT are discussed. This is the first report to support bortezomib as an important therapeutic alternative for AIHA after SOT. The occurrence and treatment of AIHA after SOT, and specifically intestinal transplantation, should be the subject of future registry studies to collect additional experience and explore the optimal therapeutic approach. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) has been shown to have benefits, including improving health‐related quality of life (HRQOL). However, there are few and conflicting studies assessing PA and its relationship with HRQOL in a pediatric solid‐organ transplant (SOT) population. The aim of this study was to assess whether overall HRQOL was associated with PA and to determine whether that association was independent of other baseline and contemporaneous clinical and demographic indicators. Methods: A retrospective cross‐sectional review was performed on 55 pediatric transplant patients (13 heart, 27 kidney, and 15 liver transplant). PA was measured by PAQ‐C/PAQ‐A, and HRQOL was measured using PedsQL. Demographics, baseline, and contemporaneous data were collected. Results: There were no significant differences in baseline and contemporaneous characteristics between heart, kidney, and liver transplant recipients. SOT recipients were 15.0 (11.0–18.0) years old at completion of surveys. Median PAQ score was 2.3 (1.6–3.2), PedsQL total score was 77 (65–91), and PedsQL physical functioning score was 88 (72–97). The PedsQL total score was not significantly associated with PAQ score. The PAQ score was significantly associated with physical functioning subscore of the PedsQL (r = 0.37, p < 0.01). Higher physical functioning score was associated with time since transplant (r = 0.29, p = 0.031). Conclusion: Our SOT cohort has a HRQOL similar to other chronic conditions and higher than previous reported HRQOL in pediatric SOT populations. Higher levels of PA and longer time since transplant are associated with higher physical functioning scores. [ABSTRACT FROM AUTHOR]

Neutropenia is generally defined as an absolute neutrophil count in the circulation of less than 1500/mm3 and occurs in up to 25%–30% of pediatric solid organ transplant recipients (SOT) within the first year after transplantation. In the SOT population, neutropenia is most often a result of drug‐induced bone marrow suppression but can also be secondary to viral infection, nutritional deficiencies, lymphoproliferative infiltrate, and inherited causes. Outcomes for patients with neutropenia vary by degree of neutropenia and type of solid organ transplant. Management of neutropenia should begin by addressing the underlying cause, including reducing or removing medications when appropriate, treating infections, and addressing nutrient deficiencies; however, consultation with an experienced pediatric hematologist and use of granulocyte colony‐stimulating factor (G‐CSF) may be helpful in some cases. Overall, data on clinical outcomes for G‐CSF use remain limited, but observational studies may support its use in patients with infections or severe neutropenia. [ABSTRACT FROM AUTHOR]

Background: Nocardia infections are rare opportunistic infections in SOT recipients, with few reported pediatric cases. Pediatric patients with single ventricle congenital heart defects requiring HT may be more susceptible to opportunistic infections due to a decreased T‐cell repertoire from early thymectomy and potential immunodeficiencies related to their congenital heart disease. Other risk factors in SOT recipients include the use of immunosuppressive medications and the development of persistent lymphopenia, delayed count recovery and/or lymphocyte dysfunction. Methods: We report the case of a patient with hypoplastic left heart syndrome who underwent neonatal congenital heart surgery (with thymectomy) prior to palliative surgery and 2 HTs. Results: After developing respiratory and neurological symptoms, the patient was found to be positive for Nocardia farcinica by BAL culture and cerebrospinal fluid PCR. Immune cell phenotyping demonstrated an attenuated T and B‐cell repertoire. Despite antibiotic and immunoglobulin therapy, his symptoms worsened and he was subsequently discharged with hospice care. Conclusion: Pediatric patients with a history of congenital heart defects who undergo neonatal thymectomy prior to heart transplantation and a long‐term history of immunosuppression should undergo routine immune system profiling to evaluate for T‐ and B‐cell deficiency as risk factors for opportunistic infection. Such patients could benefit from long‐term therapy with TMP/SMX for optimal antimicrobial prophylaxis, with desensitization as needed for allergies. Disseminated nocardiosis should be considered when evaluating acutely ill SOT recipients, especially those with persistent lymphopenia and known or suspected secondary immunodeficiencies. [ABSTRACT FROM AUTHOR]

Emerging evidence has shown that the risk of developing COVID-19 in SOT recipients following non-lung transplantation from SARS-CoV-2 positive donors appears to be low in adults, with the transmission of SARS-CoV-2 from positive donors having only been reported in lung transplant recipients. Conclusions regarding the broad use of organs from SARS-CoV-2-positive donors remain limited, and a careful case-by-case evaluation of the donor and recipient with individualized risk stratification is still needed in the pediatric population. Abbreviations COVID-19 coronavirus disease 2019 C t cycle threshold OPTN Organ Procurement and Transplantation Network PCR polymerase chain reaction SARS-CoV-2 severe acute respiratory syndrome coronavirus 2 SOT solid organ transplantation COVID-19 has had an undeniable impact on the transplant population, including with regards to organ allocation. [Extracted from the article]

Abstract: MRSA infection following SOT is an important cause of morbidity and mortality, but epidemiology and risk factors for colonization prior to pediatric SOT remain unclear. A retrospective cohort of SOT patients ≤21 years of age from 2009 to 2014 was evaluated. Demographics, MRSA screens, timing of transplantation, and MRSA infection were abstracted. From 2013 to 2014, 130 SOT candidates were screened or had known prior MRSA infection. Seventeen patients (13%) were MRSA colonized. Liver transplant candidates were least likely to be colonized (OR 0.22, CI:0.06‐0.81, P = .02); greatest risk of colonization was in lung (OR 18.7, CI:1.9‐182.3, P = .03), abdominal multivisceral (OR 7.5, CI:1.5‐38.6, P = .02), and cardiac patients with history of cardiothoracic surgery (OR 8.0, CI:1.7‐36.0, P = .007). In univariable analysis, African American patients were more likely to be colonized (OR 7.1, CI:2.49‐19.41, P = .0005). There were 3 early MRSA infections in screened patients, incidence of 3.9%; only one in a colonized patient. Thirteen percent of screened pediatric SOT candidates were MRSA colonized, with greatest risk in lung, multivisceral and cardiac patients with prior cardiothoracic surgery. Early MRSA infection occurred in 3.9% of transplanted patients. Cardiothoracic and multivisceral organ transplant candidates may benefit the most from targeted MRSA screening. [ABSTRACT FROM AUTHOR]

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. There were no significant differences in the distribution of age, sex, or ethnicity across organ groups. Common reasons for a consultation included pretransplant evaluation, anxiety, depression, agitation, and general coping. Rates varied by organ groups. Twenty percent of consults also received a psychopharmacological evaluation, with differences in rates between organ groups. Roughly one‐third of patients required high frequency of transplant psychology/psychiatry involvement. Lung and heart patients had the highest utilization. Psychiatric diagnosis rates were identified, with adjustment (41.0%) and anxiety disorders (30.1%) being the most common. Pediatric psychology and psychiatry clinicians offer developmentally informed biopsychosocial approaches to treatment for SOT patients. Clarifying the prevalence and nature of behavioral health care provided by organ group can help pediatric providers better understand appropriate psychosocial interventions and resources utilized by this patient population and ultimately guide centers toward a more unified approach to care. [ABSTRACT FROM AUTHOR]

Bunin N, Guzikowski V, Rand ER, Goldfarb S, Baluarte J, Meyers K, Olthoff KM. Solid organ transplants following hematopoietic stem cell transplant in children. Pediatr Transplantation 2010: 14:1030-1035. © 2010 John Wiley & Sons A/S. SOT may be indicated for a select group of pediatric patients who experience permanent organ failure following HSCT. However, there is limited information available about outcomes. We identified eight children at our center who received an SOT following an HSCT. Patients were six months to 18 yr at HSCT. Diseases for which children underwent HSCT included thalassemia, Wiskott-Aldrich syndrome, Shwachman-Diamond/bone marrow failure, sickle cell disease (SCD), erythropoietic porphyria (EP), ALL, chronic granulomatous disease, and neuroblastoma. Time from HSCT to SOT was 13 days to seven yr (median, 27 months. Lung SOT was performed for two patients with BO, kidney transplants for three patients, and liver transplants for three patients (VOD, chronic GVHD). Seven patients are alive with functioning allografts 6-180 months from SOT. Advances in organ procurement, operative technique, immunosuppressant therapy, and infection control may allow SOT for a select group of patients post-HSCT. However, scarcity of donor organs available in a timely fashion continues to be a limiting factor. Children who have undergone HSCT and develop single organ failure should be considered for an SOT if there is a high likelihood of cure of the primary disease. [ABSTRACT FROM AUTHOR]

Background: Adolescent and young adult (AYA) solid organ transplant (SOT) recipients experience increased rates of rejection and graft loss surrounding the time of health care transition, in part due to poor medication adherence. This study aims to examine the impact of a once‐daily formulation of tacrolimus, LCP‐tacrolimus (LCPT), on medication adherence for AYA SOT patients. Methods: A retrospective descriptive analysis was performed for all patients who underwent SOT and were prescribed LCPT after the age of 12 at our single‐center pediatric hospital. Medication adherence was assessed via provider documentation and the medication level variability index (MLVI). Results: Twenty‐nine patients were prescribed LCPT as part of their immunosuppression regimen. Twenty patients were converted to LCPT from immediate‐acting (IR) tacrolimus; six patients were initiated immediately following transplant, and three patients were unable to receive LCPT due to insurance denial. There was a numeric improvement in medication adherence for converted patients when measured by provider assessment (45.0% vs. 68.4%, p =.140) and MLVI (40.0% vs. 71.4%, p =.276), though these did not reach statistical significance. There were no differences in episodes of rejection or adverse effects. LCPT prescription was not associated with decreased medication burden, and two patients transitioned back to IR tacrolimus due to increased cost. Conclusions: LCPT use did not significantly improve patient adherence; however, it resulted in numerically higher perceived and measured adherence rates. LCPT appears to be safe and effective in the management of SOT recipients; however, it may not affect pill burden and may result in a higher financial burden. Use may be considered for a select group of AYA SOT recipients. [ABSTRACT FROM AUTHOR]

Background: Third‐dose mRNA COVID‐19 vaccine is currently recommended in the United States for SOT recipients based in part on data showing diminished immune response, including Ab production, after a two‐dose regimen. Data on vaccine response in adolescent and young adult SOT recipients are limited, including no data reported on third‐dose responsiveness. Methods: Results of serologic testing in a convenience sample of 28 vaccinated adolescent and young adult HT recipients at a single institution were collected from the medical record and summarized. Results: At a median of 98.5 days (IQR 59–150) after second dose, 17 (61%) had an Ab response. Among 12 who had serology before and after third‐dose vaccination, four of seven who were negative prior to third dose became positive at a median of 34 days (IQR 31–39.5) following third dose. No myocarditis, acute rejection, graft dysfunction, graft loss, or deaths were observed. Conclusions: These findings support recommendations for the routine administration of three doses of mRNA vaccines in adolescent and young adult HT recipients and show a potential subpopulation in whom the fourth dose should be contemplated. [ABSTRACT FROM AUTHOR]

Living with end‐stage organ failure is associated with an accumulation of traumatic medical events, and despite recovery after solid‐organ transplantation (SOT), many children continue to exhibit lower quality of life (QOL). Few studies have examined the relationship between post‐traumatic stress disorder (PTSD) and QOL among pediatric SOT recipients. We conducted a retrospective, cross‐sectional review of 61 pediatric SOT recipients (12 heart, 30 kidney, and 19 liver) to evaluate the association of PTSD with self‐reported QOL. PTSD was measured by the Child Trauma Screening Questionnaire (CTSQ), and QOL was measured using the PedsQL and PedsQL Transplant Module (PedsQL‐TM) surveys. Demographics, baseline, and contemporaneous factors were tested for independent association. SOT recipients were 15.2 (12.1–17.6) years old at survey completion. Median CTSQ score was 2 (1–3), highest in kidney recipients, and 13% were identified as high risk for PTSD. Median PedsQL score was 83 (70–91) and significantly associated with the CTSQ score (r = −.68, p <.001). Median PedsQL Transplant Module score was 89 (83–95) and similarly associated with the CTSQ score (r = −.64, p <.001). Age at time of surveys and presence of any disability were also independently associated with PedsQL and PedsQL‐TM, respectively. When adjusted for Emotional Functioning, CTSQ remained associated with PedsQL subscores (r = −.65, p <.001). Trauma symptoms are a major modifiable risk factor for lower self‐perceived QOL and represent a potentially important target for post‐transplant rehabilitation. Additional research is needed to understand the root contributors to PTSD and potential treatments in this population. [ABSTRACT FROM AUTHOR]

The process of pediatric solid organ transplantation ( SOT) places new and increased stressors on patients and family members. Measures of family functioning may predict psychological and health outcomes for pediatric patients and their families, and provide opportunity for targeted intervention. This systematic review investigated parent and family functioning and factors associated with poorer functioning in the pediatric SOT population. Thirty-seven studies were identified and reviewed. Studies featured a range of organ populations (eg, heart, liver, kidney, lung, intestine) at various stages in the transplant process. Findings highlighted that parents of pediatric SOT populations commonly report increased stress and mental health symptoms, including posttraumatic stress disorder. Pediatric SOT is also associated with increased family stress and burden throughout the transplant process. Measures of parent and family functioning were associated with several important health-related factors, such as medication adherence, readiness for discharge, and number of hospitalizations. Overall, findings suggest that family stress and burden persists post-transplant, and parent and family functioning is associated with health-related factors in SOT, highlighting family-level functioning as an important target for future intervention. [ABSTRACT FROM AUTHOR]

Within the cohort, 275 SOT recipients with a mean age of 10.2 years (±0.3) were either at moderate (CMV R+) or high risk (CMV D +/R-) for CMV infection/disease and received valGCV prophylaxis. Given the association of dose reduction with overall CMV DNAemia occurrence and the relatively small number of post-dose adjustment breakthrough infections while receiving prophylaxis, it is possible that valGCV dose adjustment impacted post-prophylaxis CMV DNAemia. In addition, 4 (1%) patients developed CMV antiviral resistance while receiving valGCV prophylaxis; 50% had a prior valGCV dose adjustment. "Weight-ing" for an answer on optimal valganciclovir prophylaxis dosing in pediatric solid organ transplantation recipients. [Extracted from the article]

PA has been shown to have benefits in SOT patients. Studies assessing physical activity levels and its correlates in a pediatric solid‐organ transplant population are limited. The aim of this study was to assess PA levels and identify baseline and contemporaneous factors that contribute to PA in a pediatric SOT population. A retrospective cross‐sectional review was performed on 58 pediatric transplant patients (16 heart, 29 kidney, and 13 liver transplant). PA was measured by PAQ‐C or PAQ‐A. Demographics, baseline, and contemporaneous factors were collected. There were no significant differences in baseline and contemporaneous characteristics between heart, kidney, and liver transplant recipients. SOT recipients were 15.2 [12.3‐17.3] years old at time of completing the PAQ. Median PAQ score was 2.2 [1.7‐2.9]. There were no significant differences in PAQ scores between organ transplant type or between genders. Lower PAQ score was associated with sensory disability (9 vs 49 without disability; P = <.01) and age at time of completing the PAQ (r = −.50, P = <.01). These results suggest that older age at time of completing the PAQ and presence of sensory disability may influence PA levels in the pediatric SOT population. [ABSTRACT FROM AUTHOR]

Re-infection/vaccine effectiveness The risk of re-infection with divergent SARS-CoV-2 variants is a point of significant concern worldwide. The impact of VOCs on vaccine efficacy and contribution to the ongoing community transmission of SARS-CoV-2 have implications for the long-term risk to SOT recipients. The publication by L'huillier I et al i addresses SARS-CoV-2 infection in pediatric solid organ transplant (SOT) patients and candidates, for which data remain scarce. [Extracted from the article]

Background: Cryptococcus neoformans is the third most common cause of invasive fungal infection in solid organ transplant (SOT) recipients. While cryptococcal infection can involve any organ, cases of myocarditis are exceedingly rare. Methods: A retrospective chart review was completed for this case report. Results: We present the case of a 21‐year‐old heart transplant recipient who developed disseminated cryptococcal infection with biopsy‐proven cryptococcal myocarditis. Conclusions: Cryptococcal disease in SOT recipients poses diagnostic and therapeutic challenges. There are no current guidelines for the duration of cryptococcal myocarditis treatment. Repeat myocardial biopsy may play a role in guiding length of therapy. [ABSTRACT FROM AUTHOR]

Introduction: With improved survival in pediatric solid organ transplantation (SOT) care has focused on optimizing functional, developmental, and psychosocial outcomes, roles often supported by Allied Health and Nursing professionals (AHNP). However, there is a scarcity of research examining frameworks of clinical practice. Methods: The International Pediatric Transplant Association AHNP Committee developed and disseminated an online survey to transplant centers as a quality improvement project to explore AHNP practice issues. Participant responses were characterized using descriptive statistics, and free‐text comments were thematically analyzed. Responses were compared across professional groups; Group 1: Advanced Practice Providers, Group 2: Nursing, Group 3: Allied Health. Results: The survey was completed by 119 AHNP from across the globe, with responses predominantly (78%) from North America. Half of respondents had been working in pediatric transplant for 11+ years. Two‐thirds of respondents were formally funded to provide transplant care; however, of these not funded, over half (57%) were allied health, compared to just 6% of advance practice providers. Advanced practice/nursing groups typically provided care to one organ program, with allied health providing care for multiple organ programs. Resource constraints were barriers to practice across all groups and countries. Conclusion: In this preliminary survey exploring AHNP roles, professionals provided a range of specialized clinical care. Challenges to practice were funding and breadth of care, highlighting the need for additional resources, alongside the development of clinical practice guidelines for defining, and supporting the role of AHNP within pediatric SOT. Professional organizations, such as IPTA, can offer professional advocacy. [ABSTRACT FROM AUTHOR]

The International Pediatric Transplant Association convened an expert consensus conference to assess current evidence and develop recommendations for various aspects of care relating to post‐transplant lymphoproliferative disorders after solid organ transplantation in children. In this report from the Viral Load and Biomarker Monitoring Working Group, we reviewed the existing literature regarding the role of Epstein‐Barr viral load and other biomarkers in peripheral blood for predicting the development of PTLD, for PTLD diagnosis, and for monitoring of response to treatment. Key recommendations from the group highlighted the strong recommendation for use of the term EBV DNAemia instead of "viremia" to describe EBV DNA levels in peripheral blood as well as concerns with comparison of EBV DNAemia measurement results performed at different institutions even when tests are calibrated using the WHO international standard. The working group concluded that either whole blood or plasma could be used as matrices for EBV DNA measurement; optimal specimen type may be clinical context dependent. Whole blood testing has some advantages for surveillance to inform pre‐emptive interventions while plasma testing may be preferred in the setting of clinical symptoms and treatment monitoring. However, EBV DNAemia testing alone was not recommended for PTLD diagnosis. Quantitative EBV DNAemia surveillance to identify patients at risk for PTLD and to inform pre‐emptive interventions in patients who are EBV seronegative pre‐transplant was recommended. In contrast, with the exception of intestinal transplant recipients or those with recent primary EBV infection prior to SOT, surveillance was not recommended in pediatric SOT recipients EBV seropositive pre‐transplant. Implications of viral load kinetic parameters including peak load and viral set point on pre‐emptive PTLD prevention monitoring algorithms were discussed. Use of additional markers, including measurements of EBV specific cell mediated immunity was discussed but not recommended though the importance of obtaining additional data from prospective multicenter studies was highlighted as a key research priority. [ABSTRACT FROM AUTHOR]

Pediatric solid organ transplantation (SOT) is a preferred treatment for medically suitable children with end‐stage organ failure. Still, many of them have no access to transplantation owing to socioeconomic constraints or lack of transplant facilities in low‐ and middle‐income countries (LMIC). Establishing pediatric SOT programs in LMIC offers children the opportunities to receive transplant care in more familiar home environments as well as help curtail transplant tourism and improve transplant outcomes as pediatric transplantation would be performed ethically and legally. The International Pediatric Transplant Association (IPTA) is a professional organization aiming to promote safe, ethical, and high‐quality pediatric transplantation worldwide. This society paper describes major obstacles to pediatric SOT in LMIC and provides guidance on developing and/or expanding pediatric SOT programs in such countries. We also summarize available resources from the IPTA Outreach Program to help establish and support pediatric SOT programs in LMIC. [ABSTRACT FROM AUTHOR]

The challenge of evaluating of SARS-CoV-2 antibody responses among vaccinated transplant patients Keywords: Antibody; COVID-19; Immunogenicity; SARS-CoV-2; Solid organ transplant EN Antibody COVID-19 Immunogenicity SARS-CoV-2 Solid organ transplant 1 3 3 08/16/22 20220901 NES 220901 Abbreviations COVID-19 coronavirus disease 2019 SARS-CoV-2 severe acute respiratory syndrome coronavirus 2 SOT solid organ transplant INTRODUCTION Data on the immunogenicity of the COVID-19 vaccines among SOT recipients are required to formalize COVID-19 vaccine recommendations for this immunocompromised population. Nucleocapsid antibody testing is recommended to evaluate the evidence of prior infection among vaccinated populations.7 Current vaccines only produce spike protein antibody responses, while both spike protein and nucleocapsid antibody responses are seen during SARS-CoV-2 infection. [Extracted from the article]

Background: Concern about SARS‐CoV‐2 infection has increased over the possible effects on immunocompromised patients. Among them, recipients of solid organ transplantation deserve special attention. Data from the adult population suggest they may be at high risk for developing severe COVID‐19, but little data are available for pediatric solid organ transplantation recipients. Methods: From March 2020 to April 2021, KT recipients aged <21 years, routinely managed at our center, who underwent RT‐PCR testing with nasopharyngeal swabs to detect SARS‐CoV‐2 infection, were studied. Tests were performed according to clinical and/or epidemiological criteria. Results: One hundred one transplanted patients were managed at our center during the observation period. Among this population, 57 patients were tested for SARS‐CoV‐2 infection with a RT‐PCR test and were subsequently enrolled. A total of 111 swabs were performed. Twelve out of the 57 patients tested (21.1%) had a positive RT‐PCR test result. Among the positive patients, eight were symptomatic (66.7%). Median duration of symptoms and RT‐PCR positivity was two days (IQR 1–2.25) and 17 days (IQR 11–27.25), respectively. No patients required specific treatment or IS therapy reduction; no one was admitted to hospital. Conclusions: Our data show that pediatric renal transplant recipients are at low risk of clinically relevant COVID‐19, as is the healthy age‐related population. On the contrary, our results differed substantially from those seen in adult SOT recipient populations that have a high incidence and an even earlier and higher mortality rate. [ABSTRACT FROM AUTHOR]