1177. Vaccinate Lurie (VaLu) a QI Project to Improve Pediatric Pre-Transplant Immunization Rates

Abstract Background Immunization prior to transplantation is important due to post-transplant immunosuppression. According to a national study, 15% of pediatric solid organ transplant recipients were hospitalized within 5 years post-transplant for a vaccine preventable illness or RSV. At our large academic pediatric hospital approximately 53% of heart and liver transplant recipients in 2016 -2018 were up to date with tetanus and pneumococcal vaccinations. This QI project was designed to improve our pre-transplant vaccination rates to minimize post-transplant infections. Methods An interdisciplinary team was convened including pharmacists, nurses, nurse practitioners, and physicians from cardiology, hepatology, and infectious diseases. After evaluating our current processes and key drivers, we selected interventions to implement via the PDSA model. Our first intervention was to have team members gain access to our statewide vaccine database (ICARE). Our second cycle was to link ICARE to our electronic medical record system (EPIC) for automatic immunization record integration. Process Map Key Driver Diagram Results Our outcome measure was up to date tetanus and pneumococcal vaccines per the CDC recommendations by age at transplant, as documented in the medical record. We saw an improvement in immunization rates to 100% during the third quarter of 2020 with an overall rate of over 80% for late 2019 - mid 2020. With the understanding that our average wait time for a heart and liver transplant was 2.4 and 3.8 months, respectively, the initiation of our QI project and obtaining access to ICARE by our team members was likely related to the improved vaccination rates. Unfortunately, after the team stopped meeting during the pandemic our immunization completion rates have decreased in 2021, despite implementing institutional access to ICARE. Control Chart Conclusion It is possible to obtain optimal immunization rates for pneumococcal and tetanus vaccines in pediatric heart and liver transplant recipients. Our future interventions include improving vaccinations after catch-up recommendations have been made and sustaining our interventions. Additionally, we look to expand our analysis to include outcomes related to vaccine-preventable diseases after transplantation. Disclosures Jacquie Toia, DNP, RN, APN, QarTek (Board Member) Ravi Jhaveri, MD, AstraZeneca (Consultant)Dynavax (Consultant)Elsevier (Other Financial or Material Support, Editorial Stipend as Co-editor in Chief, Clinical Therapeutics)Seqirus (Consultant)

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Post-transplant eosinophilic gastrointestinal disorders and lymphoproliferative disorder in pediatric liver transplant recipients on tacrolimus

Transplant Immunology ◽

10.1016/j.trim.2021.101438 ◽

2021 ◽

pp. 101438

Author(s):

Paul Wasuwanich ◽

Irini Batsis ◽

Supharerk Thawillarp ◽

Mary K. Alford ◽

Douglas Mogul ◽

...

Keyword(s):

Liver Transplant ◽

Lymphoproliferative Disorder ◽

Gastrointestinal Disorders ◽

Transplant Recipients ◽

Post Transplant ◽

Pediatric Liver ◽

Liver Transplant Recipients ◽

Eosinophilic Gastrointestinal Disorders ◽

Pediatric Liver Transplant

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Comparison of Three Cellular Assays to Predict the Course of CMV Infection in Liver Transplant Recipients

Vaccines ◽

10.3390/vaccines9020088 ◽

2021 ◽

Vol 9 (2) ◽

pp. 88

Author(s):

Smaranda Gliga ◽

Melanie Fiedler ◽

Theresa Dornieden ◽

Anne Achterfeld ◽

Andreas Paul ◽

...

Keyword(s):

Liver Transplant ◽

Solid Organ Transplantation ◽

Solid Organ ◽

Transplant Recipients ◽

Cmv Infection ◽

Cellular Assays ◽

Risk Patients ◽

Ifn Γ ◽

Liver Transplant Recipients

To estimate protection from cytomegalovirus (CMV) replication after solid organ transplantation, CMV serology has been considered insufficient and thus CMV immunity is increasingly assessed by cellular in vitro methods. We compared two commercially available IFN-γ ELISpot assays (T-Track CMV and T-SPOT.CMV) and an IFN-γ ELISA (QuantiFERON-CMV). Currently, there is no study comparing these three assays. The assays were performed in 56 liver transplant recipients at the end of antiviral prophylaxis and one month thereafter. In CMV high- or intermediate-risk patients the two ELISpot assays showed significant correlation (p < 0.0001, r > 0.6) but the correlation of the ELISpot assays with QuantiFERON-CMV was weaker. Results of both ELISpot assays were similarly predictive of protection from CMV-DNAemia ≥500 copies/mL [CMV pp65 T-SPOT.CMV at the end of prophylaxis: area under curve (AUC) = 0.744, cut-off 142 spot forming units (SFU), sensitivity set to 100%, specificity 46%; CMV IE-1 T-Track CMV at month 1: AUC = 0.762, cut-off 3.5 SFU, sensitivity set to 100%, specificity 59%]. The QuantiFERON-CMV assay was inferior, reaching a specificity of 23% when setting the sensitivity to 100%. In conclusion, both CMV-specific ELISpot assays appear suitable to assess protection from CMV infection/reactivation in liver transplant recipients.

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Using time-varying models to estimate post-transplant survival in pediatric liver transplant recipients

PLoS ONE ◽

10.1371/journal.pone.0198132 ◽

2018 ◽

Vol 13 (5) ◽

pp. e0198132 ◽

Cited By ~ 1

Author(s):

Cindy L. Bryce ◽

Chung Chou H. Chang ◽

Yi Ren ◽

Jonathan Yabes ◽

Gabriel Zenarosa ◽

...

Keyword(s):

Liver Transplant ◽

Time Varying ◽

Transplant Recipients ◽

Transplant Survival ◽

Post Transplant ◽

Pediatric Liver ◽

Liver Transplant Recipients ◽

Time Varying Models ◽

Pediatric Liver Transplant

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Liver transplant recipients’ experiences and perspectives of a telehealth-delivered lifestyle programme: A qualitative study

Journal of Telemedicine and Telecare ◽

10.1177/1357633x19900459 ◽

2020 ◽

pp. 1357633X1990045 ◽

Cited By ~ 2

Author(s):

Amandine Barnett ◽

Katrina L Campbell ◽

Hannah L Mayr ◽

Shelley E Keating ◽

Graeme A Macdonald ◽

...

Keyword(s):

Liver Transplant ◽

Solid Organ Transplantation ◽

Exercise Programme ◽

Lifestyle Changes ◽

Solid Organ ◽

Transplant Recipients ◽

Eating Pattern ◽

Face To Face ◽

Liver Transplant Recipients ◽

Lifestyle Programme

Introduction Dietary modification and exercise are encouraged to address cardiometabolic risk factors after solid organ transplantation. However, the lived experience of attempting positive lifestyle changes for liver transplant recipients is not known. The aim of this study was to explore the experiences of liver transplant recipients and their perspectives of a 12-week telehealth lifestyle programme and assess the feasibility of this innovative health service. Methods Focus groups and one-on-one interviews were conducted with participants who had completed a 12-week, group-based, telehealth-delivered diet and exercise programme and thematic qualitative analysis was used to code and theme the data. Results In total, 19 liver transplant recipients participated in the study (25–68 years, median time since transplant 4.4 years, 63% male). Overarching themes included: (a) ‘broad telehealth advantages' which highlighted that telehealth reduced the perceived burdens of face-to-face care; (b) ‘impact of employment' which identified employment as a competing priority and appeared to effect involvement with the programme; (c) ‘adapting Mediterranean eating pattern to meet individual needs' which identified the adaptability of the Mediterranean diet supported by sessions with the dietitian; (d) ‘increasing exercise confidence' which recognised that a tailored approach facilitated confidence and acceptability of the exercise component of the programme. Discussion A telehealth lifestyle programme delivered by dietitians and exercise physiologists is an acceptable alternative to face-to-face care that can meet the needs of liver transplant recipients. There is a need to further innovate and broaden the scope of routine service delivery beyond face-to-face consultations.

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