Home About us Contact
|
Home About us Contact | ||
|
|
||
Pediatric Solid Organ Transplant Recipients (pediatric + solid_organ_transplant_recipient)
Selected AbstractsValganciclovir Dosing According to Body Surface Area and Renal Function in Pediatric Solid Organ Transplant RecipientsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 3 2009W. Vaudry Oral valganciclovir is effective prophylaxis for cytomegalovirus (CMV) disease in adults receiving solid organ transplantation (SOT). However, data in pediatrics are limited. This study evaluated the pharmacokinetics and safety of valganciclovir oral solution or tablets in 63 pediatric SOT recipients at risk of CMV disease, including 17 recipients ,2 years old. Patients received up to 100 days' valganciclovir prophylaxis; dosage was calculated using the algorithm: dose (mg) = 7 × body surface area × creatinine clearance (Schwartz method; CrCLS). Ganciclovir pharmacokinetics were described using a population pharmacokinetic approach. Safety endpoints were measured up to week 26. Mean estimated ganciclovir exposures showed no clear relationship to either body size or renal function, indicating that the dosing algorithm adequately accounted for both these variables. Mean ganciclovir exposures, across age groups and organ recipient groups were: kidney 51.8 ± 11.9 ,g * h/mL; liver 61.7 ± 29.5 ,g * h/mL; heart 58.0 ± 21.8 ,g * h/mL. Treatment was well tolerated, with a safety profile similar to that in adults. Seven serious treatment-related adverse events (AEs) occurred in five patients. Two patients had CMV viremia during treatment but none experienced CMV disease. In conclusion, a valganciclovir-dosing algorithm that adjusted for body surface area and renal function provides ganciclovir exposures similar to those established as safe and effective in adults [source] Rothia dentocariosa sepsis in a pediatric renal transplant recipient having post-transplant lymphoproliferative disordersPEDIATRIC TRANSPLANTATION, Issue 3 2006Silke Wiesmayr Abstract: Background: Rothia dentocariosa (RD) is a Gram-positive rod that colonizes the human oral cavity and can cause infective endocarditis. Result: We report on a six-yr-old boy who underwent renal transplantation for polycystic kidney disease at the age of eight months. He developed post-transplant lymphoproliferative disorders after four yr and progressive graft failure. Following chemotherapy, the patient presented with neutropenia and sepsis. RD was isolated from blood and treatment with piperacillin/tazobactam was initiated; however, the child died because of multiorgan failure. Discussion: To the best of our knowledge, this is the first case of RD sepsis in a pediatric solid organ transplant recipient. [source] Increased Ig-null B lymphocytes in the peripheral blood of pediatric solid organ transplant recipients with elevated Epstein-Barr viral loadsPEDIATRIC TRANSPLANTATION, Issue 3 2009Elizabeth Schauer Abstract:, In this study, the characteristics of Ig-null B cells in high viral load carriers were examined by four-color flow cytometry. The frequency of Ig-null B cells in patients with high, low or undetectable virus loads was found that while patients with a high load had more Ig-null cells, these cells were also present in the low and undetectable load groups. As Ig-null cells from patients with no viral load were EBV-negative, EBV infection was not absolutely required for the generation or survival of Ig-null cells. Ig-null cells were CD19+, sIg - , CD5,, CD10,, CD27,, CD23,, CD38,, and CD69, with variable surface expression of CD20 and CD40. Ig-null cells did not have a proliferating cell phenotype (Ki67 - ) and a high proportion were HLA class I - and class II - . Virus copy number in CD19+ Ig-null cell populations may be much higher than in CD19+ Ig+ cell populations. EBV infected Ig-null cells were common in blood specimens from pediatric solid organ transplant recipients and infected Ig-null cells may pose potential problems for immunotherapies that target infected B cells directly. [source] Characterization of sirolimus metabolites in pediatric solid organ transplant recipientsPEDIATRIC TRANSPLANTATION, Issue 1 2009Guido Filler Abstract:, Potential age-dependent changes of sirolimus metabolite patterns in pediatric renal transplant recipients remain elusive. Thirteen pediatric solid organ transplant recipients (10 kidney, one combined liver,kidney, two liver, mean age 8.0 ± 5.0 yr) underwent a sirolimus pharmacokinetic profile in steady-state with 10 samples drawn over 12 h post-intake to calculate the AUC0,12 h. Concentrations of sirolimus and metabolite were quantified using a validated LC-MS/MS assay and metabolite structures were identified directly in blood extracts using LC-MS/iontrap. Average sirolimus AUC0,12 h was 64.9 ± 29.7 ng h/mL. Median (range) AUC0,12 h for each metabolite (ng h/mL) was: 12-hydroxy-sirolimus 7.6 (0.2,18.8), 46-hydroxy sirolimus 3.1 (0.0,12.4), 24-hydroxy sirolimus 4.3 (0.0,12.6), piperidine-hydroxy sirolimus 3.5 (0.0,8.3), 39- O -desmethyl sirolimus 3.6 (0.0,11.3), 16- O -desmethyl sirolimus 5.0 (0.1,9.9), and di-hydroxy sirolimus 4.3 (0.0,32.5). The metabolites reached a median total AUC0,12 h of 60% of that of sirolimus. The range was 2.6,136%, indicating significant variability. In all, 77.5% of the metabolites were hydroxylated, while 39- O -desmethyl sirolimus accounted for only 8.4% of the AUC0,12 h. This is clinically relevant as 39- O -desmethyl sirolimus shows 86,127% cross-reactivity with the antibody of the widely used Abbott sirolimus immunoassay. The metabolism of sirolimus in the children included in our study differed from that reported in adults, which should be considered when monitoring sirolimus exposure immunologically. [source] Idiopathic colitis following cardiac transplantation: Three pediatric casesPEDIATRIC TRANSPLANTATION, Issue 6 2003Ghassan Wahbeh Abstract:, Colitis can cause significant morbidity in pediatric solid organ transplant recipients. In many cases, despite intensive evaluation, a specific infectious, inflammatory, or immunologic etiology is not identified, and idiopathic colitis may be the ultimate diagnosis. We defined idiopathic colitis as the presence of gastrointestinal symptoms (vomiting, diarrhea, abdominal pain) with inflammatory changes seen on intestinal biopsy in the absence of identifiable bowel disease. We describe three cases of idiopathic colitis following cardiac transplantation. In each case, the post-transplant course was complicated by persistent abdominal pain, diarrhea, and in two cases, vomiting. All three patients' post-transplant courses were marked by multiple graft rejection episodes, and all received intensified immune therapy in addition to usual maintenance immunosuppression. Differential diagnosis of the patients' gastrointestinal symptoms included drug side effect, indolent opportunistic infections, inflammatory bowel disease, post-transplant lymphoproliferative disease, and microvascular ischemic colitis. Continued symptoms led these patients to extensive evaluation including imaging studies, endoscopy and tissue biopsy, and stool, blood and tissue cultures for viral, bacterial and parasitic pathogens. Definitive differentiation presented significant diagnostic challenge, and once identifiable etiologies were excluded, the diagnosis of idiopathic colitis was assigned. We conclude that idiopathic colitis following pediatric cardiac transplantation can be a cause of significant morbidity. Endoscopic evaluation of patients who present with gastrointestinal symptoms after transplant is warranted to identify the presence of idiopathic colitis once common causes are ruled out. Further study is needed to identify its incidence, etiology, therapeutic options and prognosis. [source] Human herpesvirus 8: Is it time for routine surveillance in pediatric solid organ transplant recipients to prevent the development of Kaposi's sarcoma?PEDIATRIC TRANSPLANTATION, Issue 1 2003Article first published online: 18 JAN 200 No abstract is available for this article. [source] Adenotonsillar Hypertrophy and Epstein-Barr Virus in Pediatric Organ Transplant Recipients,THE LARYNGOSCOPE, Issue 6 2001Nina L. Shapiro MD Abstract Objectives/Hypothesis Epstein-Barr virus,related (EBV-related) lymphoid hyperplasia of the tonsils and adenoids is a precursor to post-transplantation lymphoproliferative disorder (PTLD). The incidence of post-transplantation adenotonsillar hypertrophy, a potential early sign of PTLD or EBV-related lymphoid hyperplasia, is not known. We sought to identify potential risk factors for adenotonsillar hypertrophy manifested as EBV-related hyperplasia and early PTLD in the pediatric solid organ transplant population. Study Design Cross-sectional analysis. Methods We developed a 65-point questionnaire concerning obstructive sleep disorder and upper respiratory tract infections and an 8-point focused physical examination, to identify prevalence of and risk factors for adenotonsillar hypertrophy in the pediatric transplant population. We evaluated 120 pediatric solid organ transplant recipients by parental questionnaire and focused adenotonsillar physical examination. Results Of the 120 patients, 62 had undergone liver transplantation and 58 had undergone kidney transplantation. Overall, the mean questionnaire score was 8.36 (range, 0,40) and the mean physical examination score was 3.86 (range, 1,8). Patients whose EBV serological test result was negative at the time of transplant had higher scores for both the questionnaire (mean score, 10.24) and the physical examination (mean score, 4.56) than those whose EBV serological test result was positive at the time of transplantation (scores of 7.38 and 3.30 for questionnaire and physical examination, respectively). The difference in examination scores was statistically significant (P <.003). Conclusions Epstein-Barr virus seronegativity at the time of organ transplantation is a known risk factor for PTLD, with associated risk of developing EBV-related lymphoid hyperplasia. Our results indicate a higher incidence of symptoms and signs consistent with adenotonsillar hypertrophy in the EBV seronegative population. Adenotonsillar hypertrophy may be a precursor to EBV-related lymphoid hyperplasia and PTLD and must be identified in this patient population. [source] Pediatric Health-Related Quality of Life: Feasibility, Reliability and Validity of the PedsQLÔ Transplant ModuleAMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2010J. Weissberg-Benchell The measurement properties of the newly developed Pediatric Quality of Life InventoryÔ (PedsQLÔ) 3.0 Transplant Module in pediatric solid organ transplant recipients were evaluated. Participants included pediatric recipients of liver, kidney, heart and small bowel transplantation who were cared for at seven medical centers across the United States and their parents. Three hundred and thirty-eight parents of children ages 2,18 and 274 children ages 5,18 completed both the PedsQLÔ 4.0 Generic Core Scales and the Transplant Module. Findings suggest that child self-report and parent proxy-report scales on the Transplant Module demonstrated excellent reliability (total scale score for child self-report ,= 0.93; total scale score for parent proxy-report ,= 0.94). Transplant-specific symptoms or problems were significantly correlated with lower generic HRQOL, supporting construct validity. Children with solid organ transplants and their parents reported statistically significant lower generic HRQOL than healthy children. Parent and child reports showed moderate to good agreement across the scales. In conclusion, the PedsQLÔ Transplant Module demonstrated excellent initial feasibility, reliability and construct validity in pediatric patients with solid organ transplants. [source] | ||||||||||