Sirolimus to treat chronic and steroid-resistant allograft rejection-related fibrosis in pediatric liver transplantation.

This study aimed to report our experience with the use of sirolimus in pediatric liver transplant patients with chronic rejection or steroid-resistant rejection with hepatic fibrosis, focusing on their histological evolution. All pediatric liver transplant recipients who received off-label treatment with sirolimus for chronic ductopenic rejection or cortico-resistant rejection between July 2003 and July 2022 were included in the study. All nine patients included in the study showed improvement in liver enzymes and cholestasis parameters as soon as 1-month after postsirolimus introduction. A decrease in fibrosis stage was observed in 7/9 (77.7%) patients at 36 months. All but one patient experienced an improvement in the Rejection Activity Index and ductopenia at 12 months. A single patient had to discontinue sirolimus treatment owing to nephrotic proteinuria. In conclusion, sirolimus may be a safe and effective treatment for chronic and steroid-resistant rejection and may improve allograft rejection-related fibrosis and ductal damage.

Epstein-Barr virus-associated risk factors for post-transplant lymphoproliferative disease in pediatric liver transplant recipients.

BACKGROUND: Post-transplant lymphoproliferative disorder (PTLD) are the most common de novo malignancies after liver transplantation (LT) in children. The aim of our study was to assess the role of pre-LT EBV status and post-LT EBV viral load as risk factors for developing PTLD in a cohort of pediatric LT recipients. METHODS: Data of all children who underwent LT between January 2002 and December 2019 were collected. Two cohorts were built EBV pre-LT primary infected cohort and EBV post-LT primary infected cohort. Moreover, using the maximal EBV viral load, a ROC curve was constructed to find a cutoff point for the diagnosis of PTLD. RESULTS: Among the 251 patients included in the study, fifteen PTLD episodes in 14 LT recipients were detected (2 plasmacytic hyperplasia, 10 polymorphic PTLD, 2 monomorphic PTLD, and 1 Classical-Hodgkin's lymphoma). Patients of the EBV post-LT primary infected cohort were 17.1 times more likely to develop a PTLD than patients of the EBV pre-LT primary infected cohort (2.2-133.5). The EBV viral load value to predict PTLD was set at 211 000 UI/mL (93.3% sensitivity and 77.1% specificity; AUC 93.8%; IC 0.89-0.98). In EBV post-LT primary infected cohort, patients with a viral load above 211 000 were 30 times more likely to develop PTLD than patients with a viral load below this value (OR 29.8; 3.7-241.1; p < 0.001). CONCLUSIONS: The combination of pretransplant EBV serological status with EBV post-transplant viral load could be a powerful tool to stratify the risk of PTLD in pediatric LT patients.

Alteraciones en el neurodesarrollo infantil del niño indígena Arhuaco / Neural development disorders in Arhuaco children

El objetivo principal de este estudio fue evaluar aspectos relacionados con el neurodesarrollo infantil de la población indígena arhuaca en el grupo de la primera infancia, basado en una valoración global y general de determinadas áreas o procesos de desarrollo, desde cuatro aspectos fundamentales: la motricidad gruesa, fina, audición y lenguaje, y personal social, a través de la escala abreviada del desarrollo de Nelson–Ortiz validada en el país. Se les aplicó a 55 niños menores de seis años que no tuvieran patologías crónicas o comorbilidades asociadas, en Nabusimake y Pueblo Bello, Sierra Nevada de Santa Marta, con el previo consentimiento de las autoridades locales indígenas y de sus padres, en el período abril de 2009...

The main aim of this study was to evaluate childhood neural development in the Arhuaco indigineous population in the preschool age group. The study was based on a global and overall assessment of specific neural development areas or processes, assessing four core aspects: gross motor skills, fine motor skills, audition and speech and personal and social skills, using a child development abbreviated scale designed by Nelson–Ortiz, validated in our country. The scale was applied to 55 children aged six years or less with no chronic diseases or comorbidities, in the towns of Nabusimake and Pueblo Bello, Sierra Nevada of Santa Marta...