The World Transplant Games: an incentive to improve physical fitness and habitual activity in pediatric solid organ transplant recipients.

This prospective, interventional study examined the impact of training for the WTG on levels of health-related physical fitness and habitual activity in a cohort of pediatric SOT recipients. Physical fitness (FitnessGram(®) ) and habitual activity (HAES) measures were performed on participants (n = 19) in the WTG and compared to non-participant controls (n = 14) prior to and following the WTG. Pre-WTG exercise training was provided to participants. Participants demonstrated a statistically significant improvement in their habitual weekday (6.1 ± 1.7 to 8.5 ± 1.9 h; p = 0.002) and weekend (6.3 ± 2.6 to 8.4 ± 2.5 h; p = 0.01) activity over the training period, while controls improved weekday activity only (6.3 ± 2.0 to 8.3 ± 2.1 h; p = 0.05. Weekend activity: 7.7 ± 2.7 to 8.3 ± 2.3 h; p = 0.68). Participants demonstrated a non-statistical improvement in select physical fitness parameters; however, a greater number of participants achieved healthy criterion standards for cardiovascular fitness (2 vs. 1), abdominal strength (5 vs. 3), and upper body strength (7 vs. 3) following training and participating in the WTG. The WTG can provide a positive incentive for greater levels of physical activity and promote improvements in physical fitness levels. Further study is needed to examine long-term impact on lifestyle changes and health outcomes.

Response to hepatitis A and B vaccination after pediatric heart transplant.

The determination of optimal immunization protocols for immunocompromised patients is important given limited data, the potential for decreased vaccine response, and the increased threat of infection. This retrospective study assessed the response to HA and/or HB vaccination in a cohort of 13 PHTx recipients. Descriptive statistics were applied to the data, and univariate analysis was utilized to identify possible factors associated with vaccine response. HA vaccination occurred in 12 (92%) patients of whom three (25%) became HA IgG positive post-vaccination. Eight (62%) patients had previously received HB vaccination. HB vaccination occurred in 10 (77%) patients of whom five (50%) were anti-HBS IgG positive post-vaccination. Median age at HA and HB vaccination was 10.0 yr, and median time post-PHTx was 8.2 yr. Looking at the entire patient cohort, a previous history of HB vaccination was associated with increased probability of HB vaccine success (7/8 [88%] vs. 1/5 [20%], p = 0.03). Vaccine response in this cohort of PHTx recipients was well below the rates of healthy children. Only a previous history of HB vaccination was significant for increased likelihood of vaccine response. Further study is needed to identify the optimal approach to vaccination for PHTx recipients.

Transition of transplant patients with cystic fibrosis to adult care: today's challenges.

One of the most trying ordeals for patients with cystic fibrosis is moving from one care setting to another. When the patient is facing the crisis of failing health and the need for lung transplantation, the transition can seem even more overwhelming. In Toronto, patients are transferred from pediatric to adult care at age 18. Moving a teenager with cystic fibrosis to the adult system presents many challenges, and even greater challenges arise when the patient has received a lung transplant or is awaiting one. Two pediatric and adult cystic fibrosis teams have worked closely with the lung transplant teams to create a smooth transition system. This article outlines both programs and presents a case study to explore the challenges for the teams in deciding the best place to meet the needs of the patients and their families. These families offer us a look at coping with change at a time of great stress and at how we as healthcare providers can support them through the system.