Expanding reach and impact through educational initiatives is a huge priority for IPTA. It is not always easy to travel, especially in times of COVID, so IPTA decided to change with the times and offer a more varied array of educational opportunities. The SMARTER initiative was designed as a means to spread knowledge widely across multiple platforms to IPTA members and trainees through podcasts, webinars, journal clubs, and more. These can be watched on your own time, wherever you like. Currently they are all in English, but we would love to invite members that speak other languages to develop content as well as provide input into the material presented. We hope you enjoy this material and we welcome any feedback!
Behind the Drapes Episode 2
Pediatric Liver Transplantation: Considerations for Early Extubation and Pain Control (audio only)
Behind the Drapes Episode 2 References:
1. Diaz, R., et al.,
Thoracic epidural anesthesia in pediatric liver transplantation.
Anesth Analg, 2005. 101(6): p. 1891-2.
2. Erdogan, M.A., et al.,
Effect of transversus abdominis plane block in combination with general anesthesia on perioperative opioid consumption, hemodynamics, and recovery in living liver donors: The prospective, double-blinded, randomized study.
Clin Transplant, 2017. 31(4).
3. Fullington, N.M., et al.,
Immediate extubation after pediatric liver transplantation: a single-center experience.
Liver Transpl, 2015. 21(1): p. 57-62.
4. Fumagalli, R., P. Ingelmo, and L.R. Sperti,
Postoperative sedation and analgesia after pediatric liver transplantation.
Transplant Proc, 2006. 38(3): p. 841-3.
5. Gurnaney, H.G., et al.,
Extubation in the operating room after pediatric liver transplant: A retrospective cohort study.
Paediatr Anaesth, 2018. 28(2): p. 174-178.
6. Kim, T.W. and M. Harbott,
The use of caudal morphine for pediatric liver transplantation. br> Anesth Analg, 2004. 99(2): p. 373-4, table of contents.
7. Kıtlık, A., et al.,
Ultrasound-guided transversus abdominis plane block for postoperative analgesia in living liver donors: A prospective, randomized, double-blinded clinical trial.
J Clin Anesth, 2017. 37: p. 103-107.
8. Maeda, A., et al.,
The efficacy of continuous subcostal transversus abdominis plane block for analgesia after living liver donation: a retrospective study.
J Anesth, 2016. 30(1): p. 39-46.
9. Mayhew, J.F.,
Caudal morphine for pain relief in pediatric liver transplantation: did it help?
Anesth Analg, 2005. 100(2): p. 602-3; author reply 603.
10. Milan, Z.B., et al.,
Subcostal transversus abdominis plane block for postoperative analgesia in liver transplant recipients
Transplant Proc, 2011. 43(7): p. 2687-90.
11. Moore, R.P., et al.,
In reply: erector spinae plane continuous blocks for pediatric liver transplantation
Reg Anesth Pain Med, 2020. 45(4): p. 321-322.
12. Moore, R.P., et al.,
Early experiences with the use of continuous erector spinae plane blockade for the provision of perioperative analgesia for pediatric liver transplant recipients
Reg Anesth Pain Med, 2019.
13. Ulukaya, S., et al.,
Immediate tracheal extubation of pediatric liver transplant recipients in the operating room
Pediatr Transplant, 2020. 2003. 7(5): p. 381-4
14. Visoiu, M.,
Erector spinae plane continuous blocks for pediatric liver transplantation
Reg Anesth Pain Med, 2020. 45(4): p. 321.
This webinar on setting up pediatric kidney transplant protocol was live streamed, with simultaneous translation from Spanish to English provided.
Behind the Drapes: Anesthesia and Critical Care in Pediatric Liver Transplant (audio only)
Behind the Drapes Episode 1 References:
1. Channaoui, A., et al.,
Management and outcome of hepatic artery thrombosis after pediatric liver transplantation.
Pediatr Transplant, 2020: p. e13938.
2. Gunawan, B. and B. Runyon,
The efficacy and safety of epsilon-aminocaproic acid treatment in patients with cirrhosis and hyperfibrinolysis.
Aliment Pharmacol Ther, 2006. 23(1): p. 115-20.
3. Lee, A., et al.,
Eliminating international normalized ratio threshold for transfusion in pediatric patients with acute liver failure.
Clin Transplant, 2020. 34(4): p. e13819.
4. Levy, J.H., et al.,
Antifibrinolytic Therapy and Perioperative Considerations.
Anesthesiology, 2018. 128(3): p. 657-670.
5. Lui, S.K., et al.,
Re-transplantation for Hepatic Artery Thrombosis: A National Perspective.
World J Surg, 2018. 42(10): p. 3357-3363.
6. Nacoti, M., et al.,
Coagulopathy and transfusion therapy in pediatric liver transplantation.
World J Gastroenterol, 2016. 22(6): p. 2005-23.
7. Northup, P. and B. Reutemann,
Management of Coagulation and Anticoagulation in Liver Transplantation Candidates.
Liver Transpl, 2018. 24(8): p. 1119-1132.
8. Schumacher, C., et al.,
Use of Rotational Thromboelastometry in Liver Transplantation Is Associated With Reduced Transfusion Requirements.
Exp Clin Transplant, 2019. 17(2): p. 222-230.
9. Werner, M.J.M., et al.,
Evidence for a rebalanced hemostatic system in pediatric liver transplantation: A prospective cohort study.
Am J Transplant, 2020. 20(5): p. 1384-1392.
Clinical practice recommendations for recurrence of focal and segmental glomerulosclerosis/steroid‐resistant nephrotic syndrome
Lutz T. Weber, Burkhard Tönshoff, Ryszard Grenda, Antonia Bouts, Rezan Topaloglu, Bora Gülhan, Nikoleta Printza, Atif Awan, Nina Battelino, Rasmus Ehren, Peter F. Hoyer, Gregor Novljan, Stephen D. Marks, Jun Oh, Agnieszka Prytula, Tomas Seeman, Clodagh Sweeney, Luca Dello Strologo, Lars Pape.
Recurrence of primary disease is one of the major risks for allograft loss after pediatric RTx. The risk of recurrence of FSGS/SRNS after pediatric RTx in particular can be up to 86% in idiopathic cases. There is a need for consensus recommendations on its prevention and treatment. The CERTAIN study group has therefore performed a thorough literature search based on the PICO model of clinical questions to formulate educated statements to guide the clinician in the process of decision‐making. A set of educated statements on prevention and treatment of FSGS/SRNS after pediatric RTx has been generated after careful evaluation of available evidence and thorough panel discussion. We do not recommend routine nephrectomy prior to transplantation; neither do we recommend abstaining from living donation. Special attendance needs to be given to those patients who had already experienced graft loss due to FSGS/SRNS recurrence. Early PE or IA with or without high‐dose CsA and/or rituximab seems to be most promising to induce remission. The educated statements presented here acknowledge that FSGS/SRNS recurrence after pediatric RTx remains a major concern and is associated with shorter graft survival or even graft loss. The value of any recommendation needs to take into account that evidence is based on cohorts that differ in ethnicity, pre‐transplant history, immunosuppressive regimen, definition of recurrence (eg, clinical and/or histological diagnosis) and treatment modalities of recurrence.
Early school‐age cognitive performance post–pediatric heart transplantation
Anna Gold, Bianca C. Bondi, Jenna Ashkanase, Anne I. Dipchand
As survival in pediatric heart transplantation (HTx) has improved due to medical advances, the analysis of long‐term outcomes impacting quality of life such as cognition and development becomes increasingly important. Neuropsychological assessments provide a comprehensive understanding of individual needs, allowing for the development of tailored recommendations and interventions.
Routine neuropsychological assessment was completed between 5 and 7 years of age in this cohort of pediatric HTx recipients at our center (Jan 2014‐Oct 2018), including tests of general intellect (WPPSI‐IV, WISC‐V), academics (WIAT‐II/III), perceptual‐motor abilities (Beery VMI), and memory (CMS). Relevant medical variables were collected.
Among 25 children, the median age at testing was 6.7 (IQR:5.8‐7.4) years, with a median time since HTx of 5.2 (IQR:4.8‐6.8) years. Medical diagnoses included congenital heart disease (CHD; 56%) and cardiomyopathy (44%). Cognitive functioning across the intellectual, academic, and perceptual‐motor domains fell within the low‐average range, while memory abilities fell within the average range. DSM‐5 clinical diagnoses were provided for 14 (56%) children: Intellectual Disability‐Mild (20%), Learning Disability (20%), Language Disorder (8%), and Attention‐Deficit/Hyperactivity Disorder (12%). The presence of neurological issues and/or CHD predicted poorer performance on various neuropsychological domains.
Over 50% of this cohort of pediatric heart transplant recipients seen for routine post‐HTx neuropsychological assessment received a clinical psychological diagnosis, notably higher than rates in the general population. This population requires monitoring to ensure that high risk children are identified and successfully supported in school and their community.