Retrospective Chart Review of a Single Institution's Immunological Evaluation of Pediatric Patients Listed for Solid Organ Transplantation

ABSTRACT Background Pediatric patients listed for solid organ transplantation are at high risk for undiagnosed inborn errors of immunity and secondary immunodeficiency. This study aimed to report the immunological characteristics of pediatric patients listed for solid organ transplant. Methods A retrospective chart review was conducted on a cohort of 64 pediatric patients who underwent immunological evaluation prior to solid organ transplantation at a single institution. Data were collected from electronic medical records. Results The majority of the patients were evaluated for multivisceral transplant (68%) and 52% of the 64 patients underwent transplantation. The mortality rate was 16%, with sepsis being the most common cause of death. Laboratory abnormalities included T (53%), B (12%), and NK (35%) cell lymphopenia, low immunoglobulin levels (22% IgG, 11% IgM, 11% IgA), and poor pneumococcal titers (67%). Genetic testing identified known monogenetic inborn errors of immunity in 2 patients. Conclusion This study emphasizes the importance of immunological evaluation in pediatric patients listed for solid organ transplant. The findings support the need for tailored post‐transplant care, including vaccination, monitoring of immunoglobulin levels, and genetic testing, as pre‐transplant evaluation led to changes in patient management. Pre‐transplant screening can identify underlying immunodeficiencies, guide immunosuppression protocols, and improve long‐term transplant outcomes. Further research is needed to establish the broader applicability of genetic testing and optimize strategies for post‐transplant complications. Immunological evaluation should be considered a valuable tool in optimizing pediatric solid organ transplant outcomes.