Number Of Pediatric Transplants Research Articles

Abstract 8999: Impact of Coronavirus 2019 on Pediatric and Adult Heart Transplantation Waitlist Activity and Mortality in the United States

Introduction: Transplant centers saw a reduction in solid organ transplantation since the beginning of the coronavirus 2019 (COVID-19) pandemic in the United States. Limited data exists on the impact of COVID-19 on pediatric heart transplant volume and variation in transplant practices. We hypothesized that pediatric heart transplant activity decreased during COVID-19 with associated increased waitlist mortality. Methods: The United Network for Organ Sharing (UNOS) database was used to identify waitlisted patients from 2017-2020. Regional and Statewide data was obtained from US Census Bureau. CovidActNow project was used for Covid-19 mortality rates. Results: Among pediatric patients, average time on the waiting list decreased by 28 days. Even though the average number of pediatric transplants (n=39) did not change during 2020, there was a temporal decline in the first quarter followed by an increase. Overall pediatric waitlist mortality decreased from 5.31 to 4.73, however female mortality increased by 2%. Regional differences in pediatric mortality included: Northeast, decreased by 7.5%; Midwest, decreased by 9%; West, increased by 3.5%; and South, increased by 13%. North Dakota (0.55), Oklahoma (0.21) and Hawaii (0.33) showed higher mortality per 100,000 than other states. In adults, average time on waiting list increased by 40 days and there was an increase in the number of transplants from 242.06 to 266.09. Adult waitlist mortality had a larger decrease from 18.44 to 15.70 with increase in female mortality of 7%. Regional differences in adult mortality included: Northeast, decreased by 3%; Midwest, increased by 5.5%; West, increased by 4.5% and South, decreased by 5%. Iowa (0.37), Wyoming (0.22), Arkansas (0.18) and Vermont (0.19) had higher mortality per 100,000 than other states . Conclusions: Pediatric heart transplant volume declined in early 2020 followed by an increase, while transplant volume in adults increased. Although, overall waitlist mortality for pediatrics decreased, female waitlist mortality increased. Regional differences in waitlist mortality were also observed. Future studies are needed to understand this initial correlation and to determine the impact of COVID-9 on heart transplant recipients.

Hematopoietic cell transplantation in Latin America

The first bone marrow transplantation in Latin America was performed more than 30 years ago and since then several countries have started transplant programs. The Center for International Blood and Marrow Transplant Research captured information on 13 473 transplants performed in Latin America from 1981 to 2009. The current report summarizes this activity. Argentina, Mexico, and Brazil have the largest activity in the region. Despite increase in the annual number of transplants, the activity is limited to sibling donor and autologous transplants. Indications are similar to other regions with a proportionally higher number of pediatric transplants for treatment of non-malignant diseases. Unrelated donor transplant activity is also increasing through collaborations with international donor registries and the development of the first national donor registry in Brazil. Umbilical cord transplants were also reported in Latin American centers, mainly in Brazil and most commonly used for treatment of children with malignant diseases. In conclusion, hematopoietic cell transplantation is routinely performed in several centers in Latin America. However, the activity is low compared to the population in need. Challenges with costs of transplantation, donor availability, number of centers of excellence, and trained personnel need to be addressed for further development of this field in the region. Additionally, more integration between countries and transplant centers is an important next step and can assist in improving awareness for the field and maximizing the transplant activity in Latin America.

Research agenda for pediatric gastroenterology, hepatology and nutrition: transplantation. Report of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition for the Children's Digestive Health and Nutrition Foundation.

Research agenda for pediatric gastroenterology, hepatology and nutrition: transplantation. Report of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition for the Children's Digestive Health and Nutrition Foundation.

Clinical study of 18 pediatric cadaveric renal transplantations: organ sharing in pediatric renal transplantation after enforcement of the organ transplant law in Japan

Renal transplantation is considered to be the optimal replacement therapy for children with end-stage renal disease. However, the number of pediatric renal transplants in Japan is much lower than in the USA and/or Europe. Since October 1997, pediatric(< 15 years) recipients are given priority over adult recipients for organ sharing, only if one or two HLA-DR antigen(s) are matched between the recipient and pediatric(< 15 years) donor. However, the number of pediatric transplants is not increasing. One hundred and twenty-four pediatric renal transplantations were performed in Tokyo Women's Medical University between 1983 and 1999, of which 18(14.5%) were cadaveric transplants and the others (106, 85.5%) were living-related transplants. We examined 18 pediatric cadaveric renal transplantations. Seven patients received their graft from pediatric donors less than 15 years of age and 11 from adult donors. The mean age at transplantation was 13.2 years (range 4.5-18.7 years). Major etiologies of renal disease are hereditary renal disease(38.8%), chronic glomerulonephritis(33.3%), and focal segmental glomerulosclerosis[FSGS] (16.7%). Zero matches in HLA-DR locus were observed in 72.2%. Patient survival rate was 100%. Graft survival rates at 1 and 5 years after transplantation were 83% and 64% successively. There was no significant difference between the graft survival of cadaveric and living-related transplantation at 1 and 5 years. All 5 patients who received their graft between 1994 and 1998 have maintained normal graft function. Causes of their graft loss were chronic rejection in 3, recurrence of FSGS in 2, primary non-function in 1, and graft thrombosis in 1. Donor age and HLA-DR mismatching did not affect the outcome. We propose that pediatric renal grafts should be provided to children with priority, regardless of their HLA-A, B and HLA-DR matching.