Care of Pediatric Solid Organ Transplant Recipients: An Overview for Primary Care Providers

Abstract

As the number of living pediatric solid organ transplant (SOT) recipients continues to grow, there is an increased likelihood that primary care providers (PCPs) will encounter pediatric SOT recipients in their practices. In addition, as end-stage organ failure is replaced with chronic medical conditions in transplant recipients, there is a need for a comprehensive approach to their management. PCPs can significantly enhance the care of immunosuppressed hosts by advising parents of safety considerations and avoiding adverse drug interactions. Together with subspecialty providers, PCPs are responsible for ensuring that appropriate vaccinations are given and can play an important role in the diagnosis of infections. Through early recognition of rejection and posttransplant complications, PCPs can minimize morbidity. Growth and development can be optimized through frequent assessments and timely referrals. Adherence to immunosuppressive regimens can be greatly improved through reinforcement at every encounter, particularly among adolescents. PCPs can also improve long-term outcomes by easing the transition of pediatric SOT recipients to adult providers. Although guidelines exist for the primary care management of adult SOT recipients, comprehensive guidance is lacking for pediatric providers. In this evidence-based overview, we outline the main issues affecting pediatric SOT recipients and provide guidance for PCPs regarding their management from the first encounter after the transplant to the main challenges that arise in childhood and adolescence. Overall, PCPs can and should use their expertise and serve as an additional layer of support in conjunction with the transplant center for families that are caring for a pediatric SOT recipient.

Self-management in adults after solid-organ transplantation: a scoping review protocol

“…This focus is reasoned by the distinctness of children from adults in terms of organ transplantation and self-management and specific corresponding needs and challenges. 81–85 Another limitation is that only German-language and English-language evidence will be included; relevant findings from evidence written in other languages may thus be neglected. Under certain circumstances, this can lead to relevant findings being overlooked.…”

“…This ScR focuses on an adult population which will not allow conclusions to be drawn about paediatric or adolescent recipients. This focus is reasoned by the distinctness of children from adults in terms of organ transplantation and self-management and specific corresponding needs and challenges 81–85. Another limitation is that only German-language and English-language evidence will be included; relevant findings from evidence written in other languages may thus be neglected.…”

Adult and late adolescent complications of pediatric solid organ transplantation

“…Skin cancer is second most common type of cancer among adults with history of pediatric SOT 46 and affects up to 17% of patients, 47 a rate that is 3 times higher than the general population 1,48 (Figure 2). It should be noted that this risk is not limited to adults: 16% of skin cancers following pediatric SOT will develop in childhood 49 .…”

“…Outcomes in pediatric solid organ transplantation (SOT) have improved significantly over the last 30 years, with 80% of recipients surviving to adolescence or young adulthood 1 . With over 51 000 pediatric transplants since 1988, there is a growing population of long‐term survivors who are developing complications and comorbidities in late adolescence and adulthood that are related to long‐term immunosuppression and childhood organ failure.…”

A quick algorithmic review on management of viral infectious diseases in pediatric solid organ transplant recipients

“…Among this vulnerable population, delayed detection and management of viral infections can lead to significant levels of morbidity and mortality ( 8 , 9 ). The most commonly observed viral infections following solid organ transplantation include CMV, EBV, HSV, VZV, adenoviruses, BK polyomavirus, and respiratory viruses like Influenza ( 10 , 11 ).…”