Shared Care After Pediatric Nonmalignant Hematopoietic Cell Transplantation

Children undergoing hematopoietic cell transplantation (HCT) for nonmalignant disorders are increasingly surviving long-term, shifting the focus from procedural success to durable immune recovery, infection prevention, revaccination, organ health, development, and quality of life. General pediatricians play a central role in shared care after HCT, as children transition from transplant-centered monitoring back to community-based care. Post-HCT immune recovery is heterogeneous and depends on diagnosis, donor source, graft source, conditioning, serotherapy exposure, graft-versus-host disease (GVHD), immunosuppression, and prior infections. Infection risk persists beyond neutro-phil recovery and may be prolonged in children with delayed T-cell or B-cell recovery, chronic GVHD, or ongoing immunosuppression. Revaccination is essential, as pretrans-plant immunity is often lost. This review provides a practical framework for pediatricians caring for children after nonmalignant HCT, with emphasis on infection prevention, immunization, survivorship monitoring, and the emerging role of data-driven tools to support individualized follow-up.