Pediatric transplantation in Europe during the COVID-19 pandemic: Early impact on activity and healthcare

The current pandemic SARS-CoV-2 has required an unusual allocation of resources that can negatively impact chronically ill patients and high-complexity procedures. Across the European Reference Network on Pediatric Transplantation (ERN TransplantChild), we conducted a survey to investigate the impact of the COVID-19 outbreak on pediatric transplant activity and healthcare practices in both solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT). The replies of 30 professionals from 18 centers in Europe were collected. Twelve of 18 centers (67%) showed a reduction in their usual transplant activity. Additionally, outpatient visits have been modified and restricted to selected ones, and the use of telemedicine tools has increased. Additionally, a total of 14 COVID-19 pediatric transplanted patients were identified at the time of the survey, including eight transplant recipients and six candidates for transplantation. Only two moderate-severe cases were reported, both in HSCT setting. These survey results demonstrate the limitations in healthcare resources for pediatric transplantation patients during early stages of this pandemic. COVID-19 disease is a major worldwide challenge for the field of pediatric transplantation, where there will be a need for systematic data collection, encouraging regular discussions to address the long-term consequences for pediatric transplantation candidates, recipients, and their families.     

Intra‐arrest formation of right‐heart thrombi – a case illustrated by real‐time ultrasonography

The presence of free‐floating right‐heart thrombus has been reported in a cardiac arrest patient in the periarrest period. Free‐floating right atrial thrombus is a rare phenomenon seen in patients developing severe pulmonary embolism, and is associated with increased mortality. However, there have been no previously reported cases of right‐heart thrombus formation during a resuscitated cardiac arrest. We present the pre‐hospital case of a woman in the clinical setting of cardiogenic shock due to acute myocardial infarction who developed asystolic cardiac arrest on the scene. Recent implementation of ultrasonography into the regional pre‐hospital care protocol enabled sonographic investigation before and during cardiac arrest. This allowed detection of right atrial septal thrombus formation in the course of advanced life support and its migration through the tricuspid valve. The pathophysiological consequences, clinical significance and potential therapeutic options are discussed.     

Vaccination practices in pediatric transplantation: A survey among member centers of the European reference network TransplantChild

Background

There is considerable variation in vaccination practices between pediatric transplant centers. This study aims to evaluate active immunization attitudes and practices among ERN-TransplantChild centers and identify potential areas of improvement that could be addressed by shared evidence-based protocols.

Methods

A cross-sectional questionnaire of attitudes and practices toward immunization of pediatric SOT and HSCT candidates and recipients was sent to a representative member of multidisciplinary teams from 27 European centers belonging to the ERN-TransplantChild.

Results

A total of 28/62 SOT programs and 6/12 HSCT programs across 21 European centers participated. A quarter of centers did not have an on-site protocol for the immunizations. At the time of transplantation, pediatric candidates were fully immunized (80%–100%) in 57% and 33% of the SOT and HSCT programs. Variations in the time between vaccine administration and admission to the waiting list were reported between the centers, with 2 weeks for inactivated vaccines and variable time (2–4 weeks) for live-attenuated vaccines (LAVs). Almost all sites recommended immunization in the post-transplant period, with a time window of 4–8 months for the inactivated vaccines and 16–24 months for MMR and Varicella vaccines. Only five sites administer LAVs after transplantation, with seroconversion evaluated in 80% of cases.

Conclusions

The immunization coverage of European pediatric transplant recipients is still inconsistent and far from adequate. This survey is a starting point for developing shared evidence-based immunization protocols for safe vaccination among pediatric transplant centers and generating new research studies.     

Gliadin Peptides Activate Blood Monocytes from Patients with Celiac Disease

To elucidate the role of innate immune responses in celiac disease, we investigated the effect of gliadin on blood monocytes from patients with celiac disease. Gliadin induced substantial TNF-α and IL-8 production by monocytes from patients with active celiac disease, lower levels by monocytes from patients with inactive celiac disease, and even lower levels by monocytes from healthy donors. In healthy donor monocytes gliadin induced IL-8 from monocytes expressing HLA-DQ2 and increased monocyte expression of the costimulatory molecules CD80 and CD86, the dendritic cell marker CD83, and the activation marker CD40. Gliadin also increased DNA binding activity of NF-κB p50 and p65 subunits in monocytes from celiac patients, and NF-κB inhibitors reduced both DNA binding activity and cytokine production. Thus, gliadin activation of HLA-DQ2⁺ monocytes leading to chemokine and proinflammatory cytokine production may contribute to the host innate immune response in celiac disease.     

血管控制技术在近端结肠癌手术中的应用

目的评价血管控制技术在近端结肠癌手术中的应用效果。方法回顾分析2003年9月-2007年9月治疗的96例右半结肠切除患者的临床病理资料,比较常规手术组(52例)和应用血管控制技术手术组(44例)的手术时间、术中出血量、第3站淋巴结清扫个数及术后胃肠功能恢复时间。结果两组的手术时间、术中出血量、第3站淋巴结清扫个数和术后胃肠功能恢复时间分别为(102.8±63)min和(65.6±33)min,(155.3±90)ml和(82.6±40)ml,(3.65±3)个和(6.45±5)个,(72.6±57)h和(81.2±63)h。与常规手术相比,改良后的手术时间明显缩短,出血量明显减少,第3站淋巴结清扫个数明显增加,差异均有统计学意义(P<0.05);术后胃肠功能恢复时间稍有延长,但差异无统计学意义(P>0.05)。结论近端结肠癌应用血管控制技术手术切除可明显缩短手术时间,减少出血量,增加第3站淋巴结清扫个数。