Solid organ transplant (SOT) candidates and recipients are a fragile population, in which the presence of a pre-transplant disease leading to organ insufficiency and the post-transplant immunosuppressive treatment expose them to an increased risk of infectious diseases. The best intervention to guarantee efficient prevention of infections, with optimal cost–benefit ratio, is represented by vaccination programs; however, the response to vaccines needs that the immune system maintains a good function. This is even more relevant at paediatric age, when specific immunological conditions make transplant candidates and recipients particularly vulnerable. Paediatric patients may be naïve to most infections and may have incomplete immunization status at the time of transplant listing due to their age. Moreover, the unaccomplished development of a mature immune system and the immunosuppressive regimen adopted after transplant might affect the efficacy of post-transplant vaccinations. Therefore, every effort should be made to obtain the widest vaccination coverage before the transplantation, whenever possible. This review reports the most relevant literature, providing information on the current approach to the vaccinations in paediatric SOT candidates and recipients.

The coronavirus disease 2019 (COVID-19) pandemic and the necessary spreading control measures implemented by the governments have induced drastic changes in daily life. The reduction in mobility and strict social contact limitations are posing a great challenge, particularly for the adolescents. The purpose of this study is to investigate the psychological and emotional impact of lockdown and their relationship with resilience, on adolescents and young adults listed for liver transplant or liver trans-plant recipient. Social and demographic variables of subjects (n=66) were collected and the analyses were based on the Depression Anxiety and Stress Scales (DASS-21), and Connor-Davidson Resilience Scale (CD-RISC 25), exploring the following areas: emotional states of depression, anxiety and stress; and resilience factors. A correlation between the measured degrees of depression/anxiety and resilience was evaluated by Pearson’s correlation coefficient and linear regression models. The results showed a significant correlation between subscales: DASS depression/anxiety (r2=0.62) depression/stress (r2=0.65) CD-RISC commitment/optimism (r2=0.71). The total score of DAAS depression/anxiety/stress scales significantly diminished at the increasing of CD-RISC total score. The inverse correlation between CD-RISC and DAAS seems to refer to the subscale of the relationship between DAAS depression and CDRISC (β= –0.33, P=0.006). Our findings suggest that resilience can be a protective factor for adolescent liver transplant recipients and liver transplant candidates in mitigating the onset of negative psychological symptoms correlated with the pandemic.

The management of hepatic hemangioendothelioma (HHE) may be challenging. We aimed to review a large cohort of children who presented to our centers with symptomatic HHE in the last 16 years. We collected age at presentation, clinical features, histology, diagnostic process, management and outcome. Twenty seven patients (male/female 5/22), median age 13 days (1–1530) presented with hepatomegaly (24/27), cardiac failure (10/27), cutaneous hemangiomas (8/27), fever and anemia (6/27 each), vomiting (5/27), splenomegaly (4/27). The lesion was focal, multifocal, or diffuse in 9 patients of each group. The management included medical treatment (8/27), embolization (8/27), resection (3/27), observation (6/27), transplantation (2/27). After 16 months’ follow-up (30 days–11 years), 23/27 (85%) were alive. Diffuse lesions (4/4), cardiac failure (4/4), type II histology (4/4), age older than 6 months at diagnosis (3/4) predicted mortality (all p < 0.01). Histology showed type 1 lesion in 3/8, type 2 in 3/8, and type 3 in 2/8 with foci of angiosarcoma. Most patients with symptomatic HHE can be managed successfully with a combination of medical, radiological and surgical treatments. Patients with diffuse lesions, late presentation, cardiac failure and type II histology have a poor outcome. Diagnostic level IV. Therapeutic level IV.

Nicastro, Emanuele M.D., Ph.D.; Di Giorgio, Angelo M.D., Ph.D.; Zambelli, Marco M.D.; Ginammi, Marco M.D.; Bravi, Michela M.D.; Stroppa, Paola M.D.; Casotti, Valeria M.D.; Palladino, Raffaele M.D.; Colledan, Michele M.D.; D’Antiga, Lorenzo M.D.* Author Information

The novel Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) disease (COVID-19) represents an unprecedented public health issue for the general population and for patients with underlying chronic conditions. Compared to adults, children seem to have a milder course of the disease, with very few requiring medical attention.

The novel Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) disease (COVID-19) represents an unprecedented public health issue for the general population and for patients with underlying chronic conditions. Compared to adults, children seem to have a milder course of the disease, with very few requiring medical attention.

Mycotic aneurysm of the hepatic artery (HA) is a rare, unpredictable, and potentially lethal complication of liver transplantation (LT). Pediatric LT is not exempt from it but the related literature is rather scanty. We present our experience with post-LT mycotic aneurysm of the HA in pediatric age, describing four cases occurred with a special focus on the possible risk factors for its development and a proposal for the management of high-risk recipients.

The goal of this study was to evaluate postoperative ascites to correlate it with graft dysfunction and other complications. We therefore reviewed the files of patients transplanted between 2009 and 2014 to correlate drain losses with indication, patient and organ size, PELD, graft type, GRWR, NRBW, NGWD, cold ischemia time, histologically proven graft dysfunction, and surgical complications. Of 120 LTs in 104 patients, 48 (40%) were complicated by graft dysfunction, 43 (36%) by surgical complications, and 25 (21%) by cellular rejection. Large drain losses correlated with younger age (P=.05), graft dysfunction (P<.01), surgical complications (P<.01), chylous ascites (P=.05); there was no association with PELD, GRWR, NRBW, or NGWD. Graft dysfunction was predicted by >20mL/kg/d of ascites at age 0-2years (AUROC 0.671), and >10mL/kg/d above 2years (AUROC 0.710). The measurement of drain losses after pediatric LT could be used as a non-invasive marker of graft dysfunction. Younger recipients tend to develop larger amounts of ascites, and its persistence is associated with early complications.

BACKGROUND:Most pediatric liver transplantation (LT) centers administer long courses of prophylaxis against cytomegalovirus (CMV) without evidence of benefit and with significant drug exposure and costs. We aimed at evaluating overall outcomes, direct and putative indirect effects of CMV, possible impact of viremia and risk factors for CMV infection in pediatric LT recipients managed with ganciclovir-based preemptive therapy (PET).METHODS:The records of all the children who underwent LT between 2008 and 2014 were retrospectively analyzed.RESULTS:One hundred children were included. Three children had CMV disease; no CMV-related death or graft loss was recorded. The only identified risk factor for CMV infection was the donor/recipient serostatus (odds ratio, 17.23; 95% confidence interval, 1.88-157.87; P = 0.012), while viremia per se did not worsen LT outcomes, such as the incidence of acute rejection, Epstein-Barr virus infection, sepsis, biliary and vascular complications, nor graft dysfunction/loss or death at 3 and 5 years after LT. When compared with a historical cohort of children receiving ganciclovir prophylaxis, PET did not differ from prophylaxis for any of the selected outcomes, but was rather associated with lower antiviral drug exposure (6.4 ± 13 days vs 38.6 ± 14 days, P < 0.0001) and cost per patient (2.2 ± 3.9 k&OV0556; vs 6.6 ± 8.2 k&OV0556;, P = 0.001).CONCLUSIONS:PET is effective in controlling CMV in children receiving LT, with lower costs and lower exposure to antivirals.