Editorial on the Research TopicClinical challenges in pediatric transplant infectious diseases
The subspecialty of pediatric transplant infectious diseases (pTID) continues to flourish in parallel with advances in solid organ (SOT) and hematopoietic cell transplantation (HCT). The field is ever evolving, with expanding transplant indications as a curative option for malignant and nonmalignant diseases, more children undergoing SOT and HCT, and the increasing and varied landscape of new immunosuppressive agents and emerging immunotherapies, all contributing to a growing number of children who are at risk for a myriad of infectious diseases after transplantation (1–3). In addition, the clinical presentation and severity of the infection may differ depending on the type of immunosuppression. Lastly, new diagnostic technologies and therapeutic agents are emerging but generally lack pediatric-specific data to help guide management, further adding to the complexity clinicians face when caring for this high-risk population.
Pediatric TID is recognized as a key competency within pediatric infectious diseases requiring additional education, and case-based learning has been identified as a useful teaching strategy (4–7). As pTID clinicians and educators, we are constantly learning from the challenging questions we encounter in daily practice and the shared experiences and expertise of colleagues in the field. This special issue of Frontiers in Pediatrics is focused on addressing some of the challenges in the diagnosis, treatment, and prevention of infections in children who are transplant recipients by attempting to bridge the gap between clinical practice guidelines that lack inclusion of robust pediatric data and the clinical uncertainty providers may face at the bedside. Providing a patient-centered clinical case for context, leading pTID experts reference available published data, share their reasoning and expertise when approaching frequent clinical dilemmas, and highlight ongoing knowledge gaps in clinical practice that are potential research opportunities.
Given that the differential diagnoses and potential infectious etiologies are quite broad in this population and clinicians rarely know the putative pathogen a priori at initial presentation, syndromic topics are introduced including an approach to the transplant recipient with diarrhea, fever, and pulmonary infiltrates, and neurologic manifestations to discern a post-transplant viral meningoencephalitis. Practical perspectives on how to approach suspected donor-derived infections and how to decide whether to proceed or delay transplantation in HCT candidates with viral upper respiratory tract infections are shared. The challenges and evolving management strategies of certain pathogens, including emerging multidrug-resistant Gram-negative bacterial infections, chronic EBV DNAemia in SOT recipients, BK virus-associated hemorrhagic cystitis, and resistant CMV infections in HCT recipients are reviewed. Finally, a practical approach to immunizing SOT candidates and recipients is provided to optimize one of the most effective, yet underutilized, preventative strategies. When there is no one “right answer” to a challenging topic, authors provide a contextual framework from which clinicians can formulate a possible management plan for an individual patient.
As invited editors, it was a privilege to have the opportunity to bring together such an amazing group of junior and “seasoned” leading experts in pTID! We wish to thank all the authors and peer reviewers for their dedication and for sharing their expertise and valuable time in crafting this special pTID issue. We hope readers find the topics educational and useful to their practice. We hope this issue may also serve as an inspirational call to arms to readers who may be medical students, residents, pediatric clinicians, and physician scientists—to join a team of inquisitive, dedicated, and collaborative individuals in the dynamic and exciting subspecialty that is pTID —to work together to move the science forward for our subspecialty and, most importantly, for our patients.
Statements
Author contributions
GM: Writing – original draft, Writing – review & editing, Conceptualization, Methodology. MA: Writing – original draft, Writing – review & editing, Conceptualization, Methodology.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1.
BolonYTAtsharRAllbee-JohnsonMEstrada-MerlyNLeeSJ. Current Use and Outcome of HCT. CIBMTR US Summary Slides: HCT Trends and Survival Data. Center for International Blood & Marrow Transplant Research (CIBMTR) (2023). Available online at:https://cibmtr.org/CIBMTR/Resources/Summary-Slides-Reports (Accessed April 15, 2013).
2.
Organ Procurement and Transplantation Network. National Trends. Organ Procurement & Transplantation Network (OPTN) (2024). Available online at:https://optn.transplant.hrsa.gov/data/ (Accessed April 15, 2013).
3.
PhelanRChenMBuppCet alUpdated trends in hematopoietic cell transplantation in the United States with an additional focus on adolescent and young adult transplantation activity and outcomes. Transplant Cell Ther. (2022) 28(409):e1–10. 10.1016/j.jtct.2022.04.012
4.
The American Board of Pediatrics. Entrustable Professional Activities for Subspecialties: Infectious Diseases, EPA 4. American Board of Pediatrics (ABP) (2021). Available online at:https://www.abp.org/content/entrustable-professional-activities-subspecialties(Accessed April 15, 2023).
5.
Danziger-IsakovLAllenUEnglundJHeroldBHoffmanJGreenMet alRecommended curriculum for training in pediatric transplant infectious diseases. J Pediatric Infect Dis Soc. (2015) 4(1):4–10. 10.1093/jpids/pit079
6.
GanapathiLDanziger-IsakovLKottonCKumarDHuprikarSMichaelsMGEnglundJA. Trainee needs in pediatric transplant infectious diseases education. J Pediatric Infect Dis Soc. (2017) 6(3):301–4. 10.1093/jpids/piw062
7.
Paediatric Section of the Union of European Medical Specialists. European Training Requirements. Subspecialty: Paediatric Infectious Diseases. European Union of Medical Specialists (2024). Available online at:https://www.uems.eu/__data/assets/pdf_file/0016/64402/UEMS-2018.22-European-Training-Requirements-in-Paediatric-Infectious-Diseases-and-Immunology-final-.pdf (Accessed April 15, 2013).
Summary
Keywords
pediatric, transplant, infections, challenges, cases, solid organ transplantation (SOT), hematopoietic cell transplantation (HCT)
Citation
Maron G and Ardura MI (2024) Editorial: Clinical challenges in pediatric transplant infectious diseases. Front. Pediatr. 12:1425983. doi: 10.3389/fped.2024.1425983
Received
30 April 2024
Accepted
10 June 2024
Published
05 July 2024
Volume
12 - 2024
Edited and reviewed by
Andrew S. Day, University of Otago, New Zealand
Updates
Copyright
© 2024 Maron and Ardura.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Gabriela Maron gabriela.maron@stjude.org Monica I. Ardura monica.ardura@nationwidechildrens.org
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.