The Holiday season is upon us once again! Doesn’t it feel as if time just flies, and once again, we are back to celebrating with family and friends, and looking forward to what the upcoming year has to offer? As the first snows start to fall in the Northern Hemisphere, I know that’s how it feels for me anyway!
I am so excited to invite you all to the 12th Congress of the International Pediatric Transplant Association. The meeting will be held in the eclectic city of Austin, Texas on March 25-28, 2023. If you have yet to visit Austin, www.austintexas.org there’s no better excuse to come and discover this unique city than to join us and share new learnings in the field of pediatric transplantation. With an exciting Program, c.60 invited speakers, c. 180 abstract presenters and c. 45 sessions overall, the Congress is certain to be at the forefront of pediatric transplantation education. Please go to www.ipta2023.org/registration-hotel/registration-details to register. Early Bird registration ends on December 12th, so don’t delay on taking advantage of this Holiday treat! We look forward to seeing you there!
As we look forward to meeting up in person once again at our IPTA Congress year in 2023, let’s take a look back over what IPTA has achieved in 2022!
Here are some of the highlights:
Our IPTA Council colleague Luca dello Strologo sadly passed away this year after a long illness. We will remember him and his dedication to pediatric transplant patients always.
On a personal note, I was honored to be highlighted by my center, Stanford, acknowledging and celebrating 35 years of service to children requiring transplantation recently. You can read more about this here:
My IPTA colleague and presidential predecessor Mignon McCulloch has also just been voted South African Transplant Society President – a position not often held by a physician, a pediatrician or a female. Congratulations Mignon, and thank you for advocating for children requiring transplantation worldwide!
To all of our IPTA members, staff and volunteers, and to all pediatric transplant patients and families worldwide, I wish you a Happy Holiday Season, and all the best for 2023. See you in Austin!
Carlos O. Esquivel
IPTA is delighted to announce the launch of its inaugural Outreach Fellowship program in 2023. This program aims to develop and support the careers of young investigators/physicians/ Allied Health & Nursing Professionals from low income or low middle income countries as defined by the World Bank (Data for Low income, Low & middle income | Data (worldbank.org)
The program will offer 2 x awards of $5,000 USD per year. The deadline to apply is January 15th, 2023. Winners will be announced at the IPTA Congress in Austin in March 2023. For more information on eligibility and how to apply, please follow this link: www.tts.org/ipta-outreach/outreach-fellowship
Recently it has been all over the news that the first partial pediatric heart transplant was performed in the USA. This is a huge advancement for many reasons. There are many children born every year with unrepairable heart valve dysfunction (pulmonary atresia, truncus arteriosus, and aortic stenosis) and this is a huge problem because there are no growing heart valve implants outside of an entire heart transplant. There are mechanical valves for children, but most infants are too small for these. These mechanical valves also require lifelong anticoagulation which is not ideal in active children. Additionally, mechanical valves do not grow as the patient ages which necessitates reoperations as the child grows. There are also bioprosthetic valves (xenografts and homografts) but these too need to be replaced as the child grows and are not without other risks such as infection and calcifications. Heart transplantation is also an option, as the valves from a heart transplant do grow with the child and do not require replacement. But there is a lack of suitable donors for infants <1 year of age and the wait list mortality for this age group is high. This also requires life-long immunosuppression in a patient population with very naïve immune systems.
Researchers at Duke University and the Medical University of South Carolina have found an innovative solution. Partial heart transplantation is a new approach which involves transplantation of the heart valves only. Partial heart transplantation may offer the ability to use much lower immunosuppression as there is some immune privilege in this tissue. You might have heard of the concept of immune privilege in the past. This term was initially described by was coined by Sir Peter Medawar in the 1940s to describe parts of the body in which the introduction of foreign antigens does not elicit an inflammatory immune response. In fact, aortic homografts have been used since the early 1960s without the need for immunosuppression. There is some debate as to the actual immunogenicity of heart valves. Some studies have shown valves from transplanted hearts with severe rejection were spared 1, while others have shown the immunologic potential of these valves 2. Hill et al wrote a great review of the Immune Privilege of Heart Valves 3.
Partial heart transplantation can be performed using donor hearts with poor ventricular function and slow progression to donation after cardiac death that would normally be discarded making use of many more hearts. This amazing advancement could possibly ameliorate the need for donor hearts in children with unrepairable heart valve dysfunction and progression of these children to end-stage heart failure 4.
Dr. Tarak (Konrad) Rajab will be giving a plenary talk at IPTA’s 2023 Congress in Austin, Tx on his pivotal work on this advancement. This session will be on Monday, March 27th 14:45-15:15 CT. www.ipta2023.org/program/confirmed-speakers. Come join us to learn more!
Click Here for references
The new IPTA Membership Communications Committee was formed earlier this year with members combined from both committees. The aim of the combined committee was to continue to provide enhanced visibility of the fantastic work of IPTA team members across appropriate social media networks to help drive membership interest, especially from LMIC, Latin America, Asia and Africa.
We have continued to use active Twitter and LinkedIn accounts (thanks to our social media expert Sarah Francom) and Nima Memaran (Hannover, Germany) has produced some fantastic videos of pediatric transplantation “pillars”. Srinath Chinnakotla has led the ListServ project which is up and running.
The Committee will continue to promote the inaugural IPTA Outreach Fellowship for LMIC and also to promote student membership and mentoring schemes.
We look forward to seeing you in Texas, Austin for IPTA 2023!
The Publications Committee have decided to contribute one article to the newsletter from journals other than Pediatric Transplantation that is deemed outstanding. Please see the rationale behind the selection of this quarter’s article below.
Survival Benefit of Donation After Circulatory Death Kidney Transplantation in Children Compared with Remaining on the Waiting List for a Kidney Donated After Brain Death
Sarah J. Kizilbash, MD, MS,1 Michael D. Evans, MS,2 and Blanche M. Chavers, M Transplantation 2022;106: 575–583
In 2018, in USA, one-fifth of adult deceased donor kidney transplants were transplants donated after circulatory death (DCD). Despite the increasing use in adults, only 2.5% of children in this cohort received a DCD transplant. We share this article because this is the first study to report a survival benefit of DCD transplantation in children compared to those remaining on the waitlist and no difference in long-term graft outcomes, specifically for kidneys with warm ischemia time <15 minutes. Although in this cohort DCD transplantation was associated with a higher incidence of delayed graft function compared to patients who received a kidney donated after brain death (DBD), (adjusted odds ratio: 3.0; p<0.001), the risks of graft failure (adjusted hazard ratio: 0.89; P=0.46) and death (adjusted hazard ratio 1.2; P=0.67) were similar between DCD and DBD recipients. Based on their findings the authors suggest that DCD kidneys should be considered for pediatric candidates who lack a living donor, particularly for those with high pretransplant morbidity and mortality.
Please follow this link to view the article Survival Benefit of Donation After Circulatory Death Kidney Transplantation in Children Compared With Remaining on the Waiting List for a Kidney Donated After Brain Death.
Have you got an ethically challenging case that you’d like to share? Ask the Ethics Committee! We are looking for interesting cases to discuss with the pediatric transplant community. Your de-identified case will be presented in the next issue of the Newsletter, accompanied by analysis of the issues presented. Please submit your cases to Tom Blydt-Hansen, IPTA Ethics Committee Chair, at Tom.BlydtHansen@cw.bc.ca
The ID CARE Committee of IPTA invites those engaged in the care of pediatric liver transplant patients to participate in a brief survey. The survey aims to aid our understand the current prophylaxis strategies for pediatric liver transplantation employed around the world. Results will be shared with the IPTA community. Thank you in advance for your participation. The survey link will be open until January 30, 2023.
Do you have a burning question that you’d like to ask? The IPTA Education Committee are here and ready to answer! Please submit your questions to Katie Tait, IPTA Sections Manager, firstname.lastname@example.org
Which amongst the following is the best tool for Providers' assessment of transition readiness among adolescent and young adult kidney transplant recipients?
International Pediatric Transplant Association
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