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Infections among pediatric transplant candidates: An approach to decision-making.

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L'Huillier, Arnaud G Green, Michael Danziger-Isakov, Lara Chaudhuri, Abanti HÖcker, Britta Van der Linden, Dimitri [UCL] Allen, Upton D

INTRODUCTION: The presence of infections in the immediate pretransplant period poses challenges in decision-making. Delaying transplantation because of these infections may be required, but is associated with a risk to the potential recipient. The aim of this project was to develop a structured framework based on expert opinion to guide decision-making regarding the safety of transplantation for candidates with infection immediately before transplant, and to show how this framework can be applied to clinical scenarios. METHODS: Categories were created as follows: Category A: no delay; Category B: brief delay (≤1 week); Category C: intermediate delay (>1 week); and Category D: more prolonged or indefinite delay. A survey containing 59 clinical scenarios was sent to members of the IPTA ID CARE committee. Answers were reviewed, and the level of agreement was characterized as follows: Level 1: ≥75% agreement; Level 2:51%-74% agreement; and Level 3: ≤50% agreement. 95% CIs were calculated for the mean overall agreement across 59 scenarios. RESULTS: Among the panel, the agreement level ranged from 33% to 92% with the mean overall agreement across the 59 scenarios being 61%. For 7/59 scenarios, the lower bound of 95% CI was greater than 50%, indicating a difference at the 5% level of significance between the observed proportion and the chance level of 0.5. SUMMARY: The document provides expert opinion regarding the need to delay transplantation in the setting of different infections. The most important points in the decision to proceed to SOT included the urgency of transplantation and the severity of infection.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès libre
Publication date 2019
Language Anglais
Journal information "Pediatric transplantation" - Vol. 23, no. 3, p. e13375 [1-13] (2019)
Peer reviewed yes
Publisher Munksgaard ((Denmark) Copenhagen)
issn 1397-3142
e-issn 1399-3046
Publication status Publié
Affiliations UCL - SSS/IREC/PEDI - Pôle de Pédiatrie
UCL - (SLuc) Service de pédiatrie spécialisée
Keywords Candidate ; Infection ; Pediatric ; Solid organ transplantation
Links
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Bibliographic reference L'Huillier, Arnaud G ; Green, Michael ; Danziger-Isakov, Lara ; Chaudhuri, Abanti ; HÖcker, Britta ; et. al. Infections among pediatric transplant candidates: An approach to decision-making.. In: Pediatric transplantation, Vol. 23, no. 3, p. e13375 [1-13] (2019)
Permanent URL http://hdl.handle.net/2078.1/215832