We are all deeply committed to caring for children living with a transplant. In my case, that started over 20 years ago in Montreal and Los Angeles, where I completed my clinical transplant training. Along the way, I have had the privilege to contribute in leadership roles with the Canadian Society of Transplantation, NAPRTCS and IPTA; including on the outreach committee, ethics committee, editorial board for Pediatric Transplantation, and as host of the Vancouver IPTA 2021 Congress. I am also a researcher, passionate about understanding how immunological risk from recipient factors and HLA matching are different in children, and translating better immune monitoring into clinical care. My motivation has always been to continuously improve outcomes for transplanted children – the same children that I see in my clinic every week.

I have succeeded because I do not accept the status quo. I also believe that the best results come from consensus – and that means finding out and listening to the concerns and ideas of fellow clinicians on the front line. My time on the outreach committee enlightened me to sobering differences in the reality of transplant medicine around the world, from Bangalore to Vancouver; but also reinforced the common cause we share to improve care. Recurring themes include lack of sufficient priority for children – as a matter of medical urgency. Children remain at the back of the line when it comes to new diagnostics and therapeutics, which also ignores their unique needs with excess risk from infection, rejection and unacceptably limited survival.

I will engage with like-minded global partners, to foster and support advocacy for pediatric priority, better matching and to build capacity in pediatric transplant research collaboration and innovation. These are causes I have successfully advanced in Canada – IPTA is in the unique position to advance change worldwide.

I received my MBBS and MD (Pediatrics) degrees from Topiwala National Medical College at the University of Bombay, along with a pediatrics residency at the affiliated BYL Nair Hospital. I completed a 2nd Pediatrics residency at Children’s Hospital of Michigan/Wayne State University in Detroit and a Pediatric Nephrology fellowship at Children’s Hospital/Harvard University in Boston. I was a faculty member at the University of Florida from 1999-2012, where I received my MPH degree in Biostatistics in 2007. I then moved to Washington University and St. Louis Children’s Hospital in 2012, where I remain as a tenured Professor. I was the Division Chief and Medical director of Pediatric Kidney Transplantation at Florida from 2007-2012, and am Division Chief, Vice-Chair for Clinical Investigation and co-transplant medical director in St Louis.

Transplantation, across ALL ages and ALL organs, but most particularly to children, has been my clinical and research focus for my entire 22-year faculty career. My research output (~190 papers, 15 book chapters, lead editorship of a book on PTLD [2nd edition in press], and 2 current NIH R01 grants) are focused mostly on the over-immunosuppression complications of transplantation (infections/malignancies). I am the founding chair of IPTA’s new Communications Committee. I am on the Board of Directors of the pediatric kidney transplant consortium NAPRTCS and serve as the social media editor for IPTA’s journal Pediatric Transplantation.

We have reached a moment in organ transplantation where not many new drugs are being introduced, but many new biomarkers and tests are available. How to use these biomarkers and tests to optimally combine these drugs and modulate them over time is our current defining challenge, especially in children, whose needs for long-term graft survival are greater than for adults. We need to test and implement these biomarkers and tests worldwide in the most cost-effective fashion.

One of the biggest problem facing the renal transplant world is the issue of graft loss secondary to antibody mediated rejection. This is especially a problem in pediatric transplantation where 15% of all allografts are lost in 5 years and that number increases to 45.8% in 10 years. Thus all our pediatric patients need another allograft in their lifetime, which increases the burden of being back on dialysis and on the ever-growing wait list pool.

The recognition of Antibody mediated rejection is made when our traditional markers such as serum creatinine increases, which may be a very late finding in children especially since they receive allografts from adults and therefore may have a lot of reserve. Other biomarkers, be it urinary or blood biomarkers are the need of the hour, to be able to make an early diagnosis of rejection and to treat it.promptly.

The treatment of antibody mediated rejection is inadequate. Once Donor specific antibodies develop and antibody mediated rejection sets in, we have very few medications with an acceptable side effect profile that can be used to reverse and successfully treat it.

I look forward to working with industry and pharmaceutical companies to develop a useful, easily accessible tool kit for the diagnosis and management of antibody mediated rejection and thus improve and increase the longevity of renal allograft in pediatrics.

One key issue I see concerning pediatric transplantation involves the improvement of compliance with international guidelines. While developed nations have robust protocols and the ability to perform high-quality transplants, this is not always the case in developing countries. As an international organization, we have the unique ability to assist developing and lower-income nations to improve their guidelines for pediatric transplantation and transition. This organization can serve as a voice to advocate and put in new policies or improve upon existing guidelines in conjunction with physicians in these nations. With world-class physicians and experts in the field, our members can help to provide an unparalleled amount of support and guidance. Improvement of guidelines in lower-income nations specifically will go a long way towards improving equitable access to transplant services where they otherwise would not have them. We can utilize and leverage the multitude of connections from the members of this organization to fulfill this task. I personally have experience and connections with transplant units in the Asia region can serve as a valuable voice for the completion of projects in this region. These connections along with the large array of world-class researchers in IPTA can work together in a wide variety of research projects to identify cheaper or more efficient methods to carry out the pediatric transplant process or transition.