Long-term survival in childhood solid organ transplants

Paediatric solid organ transplant is a successful treatment for solid organ failure with prolonged graft and recipient survival over the past decade. Even though over 80 per cent of paediatric transplant recipients enjoy long-term survival into adolescence and adulthood, the risk of comorbid conditions increases over time given the very long-term exposure to transplant medications, primary end-organ disease and likely repeated transplants over their lifetime. We created a longitudinal paediatric Toronto transplant cohort study with up to 25 years of follow-up. We will create a data repository of information during transplant follow-up at The Hospital for Sick Children (SickKids) and link to available administrative databases at the Institute for Clinical Evaluative Sciences for over 1,000 children with a solid organ transplant performed at SickKids.

We aim to study:

1. the absolute risk of diabetes, hypertension, CVD, CKD, malignancy, and mortality;
2. the relative risk of outcomes to an age and sex-matched general population in Ontario; and
3. the direction, magnitude and strength of association for modifiable risk factors and development of morbidities and mortality across organ groups.

The results from this study may be used as the basis of new clinical recommendations for screening children with a solid organ transplant, treatment and lifestyle modifications to minimize the risk of subsequent morbidity and mortality.

Dr. Anne Dipchand is Professor of Pediatrics at the University of Toronto and the head of the Heart Transplant Program at the Hospital for Sick Children in Toronto.  She is currently the Associate Director – Pediatrics for the International Society of Heart and Lung Transplantation (ISHLT) Registry; the Chair of the newly formed International Pediatric Heart Failure Registry (iPHFR); the President-Elect of the International Pediatric Transplant Association (IPTA).

Dr. Dipchand clinical research focus is on registry-based analyses, having been the President of the Pediatric Heart Transplant Study (PHTS).

Dr. Vicky Lee Ng is a Professor of Paediatrics at the University of Toronto, Staff Physician in the Division of Paediatric Gastroenterology, Hepatology and Nutrition, and Medical Director of the Liver Transplant Program at SickKids.

Dr. Ng research interests focus on the functional outcomes, medical complications, and health-related quality of life of children who have survived liver transplantation (LT), and the childhood liver conditions of Biliary Atresia and Pediatric Acute Liver Failure.

Dr. Paul Nathan is Director of the AfterCare clinic in the Division of Pediatric Hematology/ Oncology at the Hospital for Sick Children (SickKids) in Toronto, a Senior Associate Scientist in the SickKids Research Institute and an Associate Professor of Pediatrics and Health Policy, Management and Evaluation at the University of Toronto.

Dr. Nathan’s research is focused on long-term outcomes in survivors of childhood cancer, especially specific “late effects” of cancer therapy, including cardiac disease and second malignant neoplasms. Much of his research focuses on health care utilization and its relationship with long-term outcomes in adult survivors of childhood cancer.

Dr. Karen Thomas is a Radiologist and Modality Lead, Body CT, Department of Diagnostic Imaging, at the Hospital for Sick Children, and Assistant Professor at University of Toronto.

Dr. Thomas research is focused on the practical, strategic and educational aspects of radiation safety and dose reduction in pediatric imaging, aimed to improve physician, manufacturer and public awareness. Her research activities have included dosimetry studies, patient cohort cumulative dose estimation, advances in pediatric CT protocols and intravenous contrast regimes, CT image quality analysis with iterative reconstruction, and physician and caregiver radiation dose awareness surveys.

Dr. Chia Wei Teoh is a Staff Paediatric Nephrologist and Medical Director of the Kidney Transplant Program at The Hospital for Sick Children. He is an Assistant Professor in the Department of Paediatrics at the University of Toronto. He is the Secretary/Treasurer of the Canadian Society of Transplantation’s Paediatric Executive Group.

Dr. Teoh’s research interests focuses on complement-mediated injury in transplantation and improving long-term outcomes in paediatric renal transplantation.

Dr. S. Joseph Kim is a staff nephrologist in the Division of Nephrology and co-­‐director of the Kidney Transplant Program at the Toronto General Hospital, University Health Network. He is an Associate Professor in the Department of Medicine and the Institute of Health Policy, Management and Evaluation at the University of Toronto. He is the past-President of the Canadian Organ Replacement Register Board of Directors, Chair of the Information System Advisory Committee at Canadian Blood Services, Vice-Chair of the Data Advisory Committee at the U.S. Organ Procurement and Transplantation Network, and the Associate Head of the Kidney, Dialysis and Transplantation program at the Institute for Clinical Evaluative Sciences.

Dr. Kim’s research interests are in the areas of access to and outcomes of kidney transplantation using data from both centre -­‐ and population-­‐based cohorts. His methodological interests include survival analysis and statistical models for causal inference.

Michael Paterson currently leads the ICES Chronic Disease and Pharmacotherapy Research Program and serves as the Ontario Site Lead for the Canadian Network for Observational Drug Effect Studies (CNODES). He is an Assistant Professor in both the Department of Family Medicine at McMaster University and the Institute of Health Policy, Management and Evaluation at the University of Toronto.

Michael’s current research interests include health services research methods, drug insurance policy, and pharmacoepidemiology.

Dr. Rahul Chanchlani recently joined as an Assistant Professor in the Department of Pediatrics, Division of Pediatric Nephrology at the McMaster Children’s Hospital after completing his 2-year fellowship at the Hospital for Sick Children (SickKids).

Dr. Chanchlani current research interest is focused on the incidence of diabetes and cardiovascular disease in pediatric solid organ transplant recipients. He is also studying the long-term outcomes in neonates and children with acute kidney injury using health administrative databases.

Dr. Bairbre Connolly is Radiologist at the Paediatric Interventional Radiology at The Hospital for Sick Children, an Associate Professor and the Earl Glenwood Coulson Chair in the Medical Imaging Department at University of Toronto.  She was a founding member of the Board of Directors of Society of Pediatric Interventional Radiology. Dr. Connolly performs the duties of a clinical interventional radiologist within IGT.

Dr. Connolly’s research focuses on a variety of clinically relevant topics to IGT, such as radiation dosimetry, vascular access and gut access, quality improvement (QI) initiatives and clinical outcomes analysis.

Dr. Melinda Solomon is a staff physician in the Division of Respiratory Medicine. She is the Medical Director of the Paediatric Lung Transplant Program and Director of the Cystic Fibrosis Clinic at SickKids. She is also the training program director for the Paediatric Respiratory Medicine Program. Dr. Solomon is Associate Professor in the Department of Paediatrics at the University of Toronto.

Dr. Solomon research interests focus on pediatric lung transplantation and clinical trials and outcomes in cystic fibrosis as well as other lung diseases.

Elevated risk of cancer after solid organ transplant in childhood: A population-based cohort study

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Validation of serum creatinine-based formulae in pediatric renal transplant recipients

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Patterns of kidney injury in pediatric nonkidney solid organ transplant recipients

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Incidence of hyperglycemia and diabetes and association with electrolyte abnormalities in pediatric solid organ transplant recipients

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Incidence of new-onset diabetes mellitus and association with mortality in childhood solid organ transplant recipients: A population-based study

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Incidence and risk factors of early surgical complications in young renal transplant recipients: A persistent challenge

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