Related Experiment Video
Updated: Jan 31, 2026
A Rat Lung Transplantation Model of Warm Ischemia/Reperfusion Injury: Optimizations to Improve Outcomes
Published on: October 28, 2021
Pediatric Outcomes in Transplant: PersOnaliSing Immunosuppression To ImproVe Efficacy (POSITIVE Study): The
Tanya Papaz1,2, Upton Allen2,3, Tom Blydt-Hansen2,4
1Division of Cardiology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
This study personalizes transplant immunosuppression for children and young adults by analyzing age-related factors. It aims to improve graft survival and reduce complications through tailored treatment strategies.
Area of Science:
- Transplant medicine
- Immunology
- Pharmacogenomics
Background:
- Current transplant immunosuppression lacks age-specific tailoring, leading to suboptimal outcomes.
- Pediatric and young adult transplant recipients face unique challenges.
- The study addresses the need for personalized immunosuppression strategies in younger populations.
Purpose of the Study:
- To personalize posttransplant immunosuppression in pediatric and young adult solid organ and hematopoietic stem cell transplant recipients.
- To identify factors influencing immunosuppression requirements across different ages and transplant types.
- To investigate viral-host interactions and medication adherence in young transplant patients.
Main Methods:
- Prospective observational cohort study across 14 Canadian transplant centers.
- Recruitment of pediatric/young adult transplant recipients and matched donors.
- Collection of clinical data, biospecimens, and pharmacy records for comprehensive analysis.
Main Results:
- 1166 participants recruited, representing diverse transplant types and age groups (0-24 years).
- High consent rates achieved for genetic, immunological, and behavioral analyses.
- Ongoing data collection and follow-up to assess outcomes.
Conclusions:
- A national multicenter network facilitated large-scale recruitment for age-specific immunosuppression research.
- The cohort's diverse characteristics will enable precision medicine approaches.
- Individualized immunosuppression strategies are key to improving transplant outcomes in young patients.
Background:
Despite age-related differences in biology, physiology, and behavior, transplant immunosuppression is not tailored by age. This likely contributes to high graft failure and posttransplant complications. We present the aims, design, and methods of the Pediatric Outcomes in Transplant: PersOnaliSing Immunosuppression To ImproVe Efficacy Study aimed at personalizing posttransplant immunosuppression in children and young adults.
Methods:
In this prospective observational cohort study, we recruited pediatric and young adult solid organ transplant, pediatric allogeneic hematopoietic stem cell transplant recipients, and matched living and deceased organ donors from 14 transplant centers across Canada. Clinical data, questionnaires, biospecimens, and pharmacy records were collected at serial time points: (1) to identify genetic and host immune factors that influence immunosuppression dose requirements across different ages and transplant types, (2) to identify viral-host interactions that increase susceptibility to Epstein-Barr virus infection, and (3) to define care processes and structures associated with medication adherence in adolescents and young adults.
Results:
From 2015 to 2018, 1662 new and prevalent transplant recipients were screened, 1166 were recruited for the various aims, including 370 liver, 445 kidney, 277 heart, 19 lung, 19 multiple, and 36 hematopoietic stem cell transplant transplants. Twelve percent were younger than 2 years, 30% were 2 to 10 years, 42% were 10 to 18 years, and 16% were 18 to 24 years at enrollment. Nine hundred thirty-one consented to participation in aims 1 and 2 (90% consent rate), 287 to aim 3 (82% consent rate). Biospecimens collected included 898 for DNA, 276 for immunoassays, and 717 for biomarker studies. Seventy percent participants have completed follow-up; 30% are pending study completion.
Conclusions:
The design of this national multicenter cross-organ network helped maximize recruitment of a large patient cohort for studying age and organ-related differences in immunosuppression needs that would not otherwise be feasible. Leveraging the unique clinical, biological, environmental, and behavioral characteristics of this cohort will help develop precision medicine strategies for individualizing posttransplant immunosuppression.
Related Concept Videos
02:50Combination Therapies and Personalized Medicine
The combination of the drug acetazolamide and sulforaphane is a good example of combination therapy to treat cancer. The cells in the interior of a large tumor often die due to the hypoxic and...
01:24Tissue Transplantation
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...
01:28Kidney Transplant I: Introduction
01:22Bone Marrow Sampling and Transplants
The transplant begins with high doses of chemotherapy and radiation treatment, which aim to destroy...
01:26Kidney Transplant II: Surgical Procedure
01:26National Nursing Organizations I