569 - A Multidisciplinary Approach to the Pre-evaluation Process of Pediatric Solid Organ Transplant Patients

Background: Pediatric transplant recipients are at increased risk of infection-related morbidity and mortality, both from opportunistic infections and vaccine-preventable diseases. Since vaccine immunogenicity may wane with organ failure and immunosuppressive therapies, it is recommended that transplant candidates are immunized early in their disease course, prior to transplant. However, transplant candidates are often incompletely immunized due to factors including complexity of care and multiple providers. A multidisciplinary approach involving Infectious Diseases (ID) is crucial to ensure that vaccination status is optimized prior to transplant and to prevent and treat infectious complications.

Methods: During the solid organ transplant evaluation process, liver, intestinal, and heart transplant candidates and their families meet with Infectious Diseases, Transplant Pharmacy, and Organ Procurement clinicians. The multidisciplinary team effort ensures that transplant candidates receive appropriate vaccines prior to transplant, based on immunization history and serology results. The team helps to manage infections diagnosed during the evaluation process (active or latent), identify risk factors for infection, optimize antimicrobial dosing based on comorbid conditions and concomitant medications, and follows patients post-transplant. Transplant candidates and their families are educated on how organ donation and organ allocation function in the US.

Results: Since launch of our multidisciplinary solid organ transplant team, we have completed pre-transplant ID evaluations on 64 patients [Table 1]. Nearly all (97%) of pre-transplant evaluated patients received vaccine optimization (booster/new vaccine doses) [Table 2]. Forty-five patients (70%) underwent organ transplant. Many intestinal (67%), cardiac (46%), and liver (27%) transplant candidates with pre-transplant evaluations required subsequent ID consultation.Table 1
Table 2


Conclusion: Multidisciplinary ID pre-transplant evaluation leads to individualized vaccine optimization and infection management. Families benefit from education and counseling as well as familiarity with the Transplant ID consult service, involved in a large percentage of these patients in their peri- and post-transplant course.