Dear IPTA Colleagues,
One of the key elements of the mission of the International Pediatric Transplant Association is to advance the science and practice of pediatric transplantation worldwide in order to improve the health of all children who require such treatment. Our pediatric transplant recipients of child-bearing age present with added complexities in terms of short and long-term outcomes. Routinely prescribed immunosuppressive medications may be associated with heightened risks to a fetus, including miscarriage, prematurity and low birth weight, as well as a risk of death for both fetus and pregnant person. Further, in spite of extensive educational programs, pregnancy in adolescent/young adult transplant recipients remains a significant problem that mimics the non-transplant population. I am very concerned that the 24 June 2022 United States Supreme Court decision to overturn Roe v. Wade will present us with challenges and ethical dilemmas in providing care to our high-risk population.
As a leader of an international organization, I recognize global approaches to reproductive healthcare access vary. No matter where we practice, the health of our transplanted patients is our top priority, including transplant recipients who may need medical intervention to prevent or end a pregnancy. We stand in solidarity with our patients requiring transplantation and will always strive for their best outcomes. Our patients already face significant racial, ethnic, and socioeconomic disparities in prenatal care and obstetric outcomes. Overturning 50+ years of progress following the implementation of Roe v. Wade will only heighten inequalities that currently exist in the transplant field. We should always advocate for and act as the voice of our patients across the globe, providing unbiased, evidence-based advice and support.
I invite you to take a look through this issue of the Newsletter, catching up with the latest happenings within the Society. As you will see, abstract submissions have opened for IPTA’s 12th Congress in March 2023. We encourage all to submit their abstracts before the deadline of 6 September 2022. We also encourage nominations for the IPTA Congress awards, as well as for Officer and Council positions.
Wherever you reside in the world, I wish you a happy summer / winter, and hope that you all remain safe and well.
Carlos O. Esquivel
COVID has been a difficult time for all. It has brought about new challenges and opportunities to the field of transplantation. There are many unanswered questions surrounding the novel corona virus and only recently have some of the answers started appearing in the literature. Data on the immunogenicity of the COVID-19 vaccines among SOT recipients have just started to emerge. Feingold et al. reported SARS-CoV-2 antibody responses following the use of COVID-19 mRNA vaccines among pediatric and young adult heart-transplant recipients 1. In their study, 61% had SARS-CoV-2 spike protein antibody responses after a 2-dose vaccination series. A subset received a third dose of an mRNA vaccine and 57% of those patients who were seronegative after the second dose of vaccine developed antibody responses after the third dose. Luigi et al. reported that 44% of adolescent/young adult kidney transplant patients who received 2 doses of the COVID mRNA vaccine seroconverted and 92% seroconverted after the third dose 2. The Center for Disease Control just recently published interim clinical considerations for COVID 19 vaccines recommending a 3-dose primary mRNA COVID-19 vaccine series for moderately or severely immunocompromised persons 5 years of age and older, followed by a booster dose for those 12 years of age and older 3.
More recently we are learning about newer antiviral drugs in SOT patients with COVID-19 infection. Prikis and Cameron recently published a paper on Paxlovid (Nirmatelvir/Ritonavir) and Tacrolimus Drug-Drug Interaction leading to incredibly high tacrolimus levels 4. We have also had a pediatric heart transplant patient reach a tacrolimus level of >60 ng/ml after receiving Paxlovid from their pediatrician.
Now that we are 2 years into this pandemic, the newest question is “Can we accept organs from COVID positive donors.” There are differing opinions on this in different organs. At least for kidney, I accepted my first positive donor recently. It was a perfect donor. Twenty-three-year-old male, head trauma, asymptomatic for COVID, terminal creatinine 0.8mg/dl, no pressors, no protein in the urine, no drugs, no past medical history. Completely healthy. BAL was positive for COVID with a cycle count of 35. I accepted the offer and 3 weeks later the child is still asymptomatic and doing great. I started asking around to other centers and some are transplanting kidneys from asymptotic donors with a cycle count of 18. I think we have a lot to learn in this area, and I hope to see some papers in the near future that address this topic. Maybe even some data will be presented at IPTA 2023 in Austin, TX. I hope to see you all there!!
IPTA is delighted to introduce our new IPTA Committee members, as outlined below for each Committee. We are proud to share that each Committee has Allied Health and Nursing Professionals represented.
It is also my pleasure to announce the merging of 2 Committees, the Communications Committee and the Membership Committee, to form the Membership Communications Committee. We decided to merge these 2 committees to serve the needs of our members as best possible, using all the means of communication at our disposal to both communicate Society news whilst helping retain and drive membership in terms of joining and staying current on payments of Society dues. This Committee will be jointly chaired by Dr. Pankaj Chandak (London, UK) and Dr. Manuel Rodriguez-Davalos (Salt Lake City, USA).
IPTA Committees 2022 – New Members
Allied Health and Nursing Professionals Committee
Louise Kipping, London, UK
Jemma Mears, Birmingham, UK
Jenny Prüfe, Essen, Germany
Gerri James – Stanford, USA (AHNP representative)
Hassina Mohammed, Trinidad & Tobago
ID Care Committee
Eunkyung Song, Columbus, USA
Membership Communications Committee
Lorraine Hamiwka, Calgary, Canada
Courtney Risley, Boston, USA (AHNP representative)
Dominique Jan, New York, USA
Jenny Wichart, Calgary, Canada (AHNP representative)
Koji Hashimoto, Cleveland, USA
Jason Vanatta, Memphis, USA
Adrianne Sikora, Aurora, USA (AHNP representative)
Identifying a gap in our offer, I have decided to form a Multi-Organ Transplant Committee. This Committee will be jointly chaired by Dr. Irene Kim (Los Angeles, USA) and Dr. Alisha Mavis (Durham, USA). Please see the formation of this exciting new Committee below. We look forward to working together on new fresh and innovative initiatives.
Co-Chair: Irene Kim, Nashville, USA
Co-Chair: Alisha Mavis, Durham, USA
Council Liaison: Carlos Esquivel,Standford, USA
AHNP Correspondant: Louise Bannister, Toronto, Canada
Sophoclis Alexopoulos, Nashville, USA
Upton Allen, Toronto, Canada
Ane Andres, Madrid, Spain
Chesney Castleberry, Austin, USA
Abanti Chaudhuri, Sunnywale, USA
Amrita Dosanjh, San Diego, USA
Katsuhide Maeda, Philadelphia, USA
Cal Matsumoto, Washington DC, USA
Agnieszka Prytula, Ghent, Belgium
Lainie Ross, Chicago, USA
Marianne Samyn, London, UK
Thozama Siyotola, Cape Town, South Africa
Riccardo Superina, Chicago, USA
Jason Vanatta, USA
For full Committee formations, please go to www.tts.org/ipta-about/ipta-about-committees. We are excited to continue our good work! If you are interested in joining an IPTA Committee, the next call for new Committee members will be in January 2023.
VISIT THE IPTA AWARDS PAGE
Nominations are closing soon for the IPTA 2023 Society Awards! Please don’t hesitate to nominate a colleague who you feel has made an invaluable contribution to pediatric transplantation.
There are 3 awards available: Lifetime Achievement, Future Leaders Career Development, and Distinguished Allied Health and Nursing Professionals. These awards will be given out at the IPTA 2023 Congress in Austin, Texas. For more information, please go to www.tts.org/ipta-about/ipta-awards.
The patient is a 14 -year-old female who had a heart transplant 4 years ago and now has developed severely depressed cardiac function from grade 3 coronary allograft vasculopathy. She has mild symptoms of fatigue with ordinary activity but has frequent ventricular ectopy. She is currently hospitalized and inotrope dependent. From a noncardiac perspective, she also has stage 3 chronic kidney insufficiency (CKD) and obesity. She was only transplanted 4 years ago but has had a difficult time maintaining therapeutic levels of her immunosuppressants. The patient has had 3 episodes of grade 3 cellular rejection in the past 2 years. She has been admitted multiple times to the hospital for inadequate levels. Interestingly, the patient has felt comfortable in the hospital and does not mind being admitted.
Prior to transplant, her family and the patient were educated on transplantation. However, since the transplant, her parents have divorced and are now in new relationships. The patient has been coming to all her appointments and all scheduled visits; however, only one parent comes, and they are not always engaged and do not know the doses of her medicines. There have been multiple meetings with family and patient to address adherence concerns. When asked about why her drug levels are not therapeutic, the patient shrugs and says she always takes the medications, and she does not know why her levels are always low. Her parents state they have talked to her about the importance of medication and believe that she is taking them. They have tried to encourage adherence and have watched her take her medications intermittently but are not always consistent. Given her progressive decline, the likelihood of needing another transplant was brought up by the parents. Parents want her to live and are adamant that they will provide the necessary support.
Would you consider this child for re-transplantation?
What are the primary factors that influence your decision to offer re - transplantation?
The patient continued to decline. Social services became involved, and parents were deemed unsuitable guardians. She was placed on mechanical circulatory support and waited in the hospital for 8 months before getting a second heart transplant at age 15 years. She and her court appointed guardians were counseled extensively on heart transplant management and care. The patient was eventually discharged with guardian. However, the patient ran away from home 1 year after her second heart transplant for 6 months. She presented again with rejection that improved with augmented immunosuppression. After this rejection episode the patient became aware of her condition and, with significant social support and help, managed to change her life. She had therapeutic levels and perfect adherence with appointments and medications the past 3 months. She is now 17 years old, currently finishing high school and was accepted to college. She wants to become a nurse. However, the patient was found to have new grade 3 CAV with severely depressed cardiac function. She does have symptoms of fatigue, abdominal pain, and shortness of breath. Inotropic support with milrinone has helped her symptoms and she is currently inotrope dependent.
Would you offer this patient a third heart transplant?
Would you offer mechanical cardiac support?
Patient is a 15-year-old male s/p Kidney transplant 8 years ago due to focal segmental glomerulosclerosis. The patient’s kidney is now failing, and he needs a second kidney transplant. The first few years after his transplant, the patient had adequate follow-up and maintained therapeutic levels of immunosuppression. However, he has missed appointments over the past 2 years. Due to loss of work from the COVID pandemic, the family had to move 3 hours away from the transplant center and they cannot come often. His mother died due to COVID complications. His father has been trying to work and care for the patient and his two sisters. For a time, they were homeless and that is why the kidney transplant team couldn’t reach the family. His family has not been able to pay for his medications and have been cutting his doses in half to try to extend the immunosuppression. The family does not have a car, so their only method of transportation is by train.
Would you consider this child for kidney re-transplantation?
What are the primary factors that influence your decision to offer re - transplantation?
The IPTA Ethics Committee is in the process of developing a survey to assess our members practices regarding organ transplantation in the setting of poor medical adherence. In preparation for that survey, we invite the members to consider these cases as well as their responses to the questions posed. We plan to proceed with a formal survey on these issues in the coming months.
Are you or do you know someone who could serve IPTA as an Officer or Councilor? Nominations are open now for the following positions:
Nominations and applications are welcome from anyone who has been an IPTA member in good standing for at least 1 year. Service to IPTA on committees or special activities relevant to the society is an asset.
Applications must be submitted by emailing Katie Tait, IPTA Section Manager at TTS at email@example.com. Please review the following and gather all of the information and documents prior to proceeding to apply.
You will be asked the following:
You will need to supply the following documents with your email application:
Applicants will be notified in December 2022 regarding the status of their acceptance to the election slate for the 2023 election.
DEADLINE FOR APPLICATIONS IS SEPTEMBER 30th, 2022
Join us for the 12th IPTA Congress and connect with the leading global pediatric transplantation community! For more information and for important dates, please go to www.ipta2023.org.
Abstract submission closes 6 September 2022.
IPTA is thrilled to announce a Pre-Congress session at TTS 2022! Based on 4 themes of lifelong immunosuppression reduction, donors for pediatric recipients, perioperative considerations in pediatric SOT and multi-organ transplantation, this exciting program features prominent IPTA members, as well as showcasing pediatric transplantation professionals from around the world. For more information please click here cm.tts2022.org/virtual/timeslot/222.