Pediatr Transplantation 2014: 18: 790–793
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Pediatric Transplantation DOI: 10.1111/petr.12355
Capacity building in pediatric transplant infectious diseases: An international perspective Danziger-Isakov L, Evans HM, Green M, McCulloch M, Michaels MG, Posfay-Barbe KM, Verma A, Allen U: The ID CARE Committee from IPTA. (2014) Capacity building in pediatric transplant infectious diseases: An international perspective. Pediatr Transplant, 18: 790–793. DOI: 10.1111/petr.12355.
Lara Danziger-Isakov1, Helen M. Evans2, Michael Green3, Mignon McCulloch4, Marian G. Michaels3, Klara M. Posfay-Barbe5, Anita Verma6 and Upton Allen7: The ID CARE Committee from IPTA
Abstract: Transplant infectious diseases is a rapidly emerging subspecialty within pediatric infectious diseases reflecting the increasing volumes and complexity of this patient population. Incorporating transplant infectious diseases into the transplant process would provide an opportunity to improve clinical outcome and advocacy as well as expand research. The relationship between transplant physicians and infectious diseases (ID) specialists is one of partnership, collaboration, and mutual continuing professional education. The ID CARE Committee of the International Pediatric Transplant Association (IPTA) views the development and integration of transplant infectious diseases into pediatric transplant care as an international priority.
1
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA, 2Starship Children’s Hospital, Auckland, New Zealand, 3Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA, 4Red Cross War Memorial Children’s Hospital, Cape Town, South Africa, 5 Children’s Hospital of Geneva, University Hospitals of Geneva, Geneva, Switzerland, 6Department of Medical Microbiology, King’s College Hospital, London, UK, 7Hospital for Sick Children, University of Toronto, Toronto, ON, Canada Key words: Pediatric – transplant – infectious diseases – education Lara Danziger-Isakov, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229 USA Tel.: 513-636-7499 Fax: 513-636-7655 E-mail: [email protected] Accepted for publication 4 August 2014
Transplant infectious diseases (ID) is a rapidly emerging subspecialty within pediatric infectious diseases reflecting the increasing volumes and complexity of this patient population. While the interest in this specialized care for pediatric patients has grown, integration into transplant care teams is inconsistent. Incorporating transplant infectious diseases into the transplant process would provide an opportunity to improve clinical outcome and advocacy as well as expand research. Further, in areas where pediatric infectious diseases specialists are not available, the proposed educational tools will help to support other transplant specialists as well as foster relationships between infectious diseases and transplantation. The ID CARE Committee of the International Pediatric Transplant Association (IPTA) views the development and integration of transplant 790
infectious diseases into pediatric transplant care as an international priority. Training and care model for infectious disease in North America
The job activity profile defined as a “pediatric infectious diseases specialist” is well established in North America and serves as a template that guides the development of the pediatric transplant ID specialist. To this end, the involvement of pediatric transplant ID in North America has undergone a significant transition and expansion in the past several years. Increasing numbers of faculty positions focused on the care of immunocompromised hosts including solid organ and stem cell transplant recipients have become available indicating an appreciation for expertise in this realm, but immersion of these
Capacity building in pediatric transplant ID
practitioners in transplantation remains uneven across institutions. In part, this is due to inconsistent training within Pediatric ID Fellowship programs. While some centers have a long track record of providing these educational experiences, this is not universally the case. Accordingly, there is a need to expand and standardize training to gain special expertise in the management and prevention of infections in pediatric transplant recipients. Variability exists in all aspects of involvement of pediatric ID specialists, from engagement in ongoing clinical care outside of acute episodic illness to program development including IDrelated education and guidelines. Some institutions have developed ID service lines specifically directed at supporting transplantation, while others have integrated expertise in a more traditional model of inpatient care. The involvement of pediatric ID in North America has gone beyond interactions directed at specific patient questions to include interactions with the broader transplant community. Pediatric ID specialists with interest and expertise in solid organ transplantation more frequently participate in the transplant infrastructure. At the local and regional level, some pediatric ID specialists have developed relationships with their local organ procurement organizations (OPOs) to provide input and expertise in the assessment of potential donors. Others have taken on roles within the U.S.’s Organ Procurement and Transplant Network (OPTN) at both the regional level and within its ad hoc Disease Transmission Advisory Committee. There has been an increasing involvement of pediatric ID specialists in academic societies focusing on solid organ transplantation including the IPTA, American Society of Transplantation, and Transplantation Society. While this level of participation may be variable and highly individual dependent, it is clearly increasing. Participation in these organizations can foster the development of networks and mentoring, which should help to facilitate opportunities for collaborative research, quality improvement projects, and advocacy which currently remain undersubscribed. Training and care models for infectious disease outside of North America
The model of infectious diseases training that exists in North America differs from that which exists in some other regions of the world. In this regard, infectious diseases expertise is not necessarily delivered by an infectious diseases special-
ist as defined by North American credentials and training. Such care might be delivered by clinical microbiologists, virologists, and to some extent specialists in particular disciplines (such as nephrology, hepatology, and gastroenterology) as discussed further below. In addition, in some countries, the burden of infectious disease may be so substantial that most general pediatricians will have broad experience in infectious diseases. Many countries now offer a pediatric ID fellowship, but this is country-dependent. The requirements are often the same as for the adult ID curriculum, with the difference that basic training in pediatrics is mandatory. To our knowledge, no country offers a specific training in pediatric transplant ID, but care of transplant candidates and recipients is often mentioned in the program objectives. The model that currently exists in the United Kingdom exists in several regions of the world outside of North America, with medical microbiologist and virologists providing support to transplant teams. A fraction of hospitals have established pediatric ID departments, and the situation is further compromised by a lack of mandatory exposure of the trainees in the management of children with solid organ transplantation. The state of affairs is similar in the rest of Europe and Asia. In addition, adult teams mainly composed of transplant surgeons and physicians related to the organ specialty often provide pediatric care in solid organ transplantation due to colocation of pediatric services in adult hospitals. ID consultants are not always part of the transplant teams and as such are not involved in the day to day decision-making on ID management. Further, many centers have a comparatively low number of transplantations each year. Therefore, physicians interested in pediatric transplant ID often choose to train in North America. However, there is no traditional pathway to acquire experience. In the above context, given differences in the models of care offered by individuals delivering pediatric ID expertise to their respective transplant teams, it will be important to determine how best to adapt current training curricula to meet the needs of these individuals until such time when pediatric infectious training programs are more firmly established. Newly approved curriculum for North American training and application inside and outside of North America
The recently published Recommended Curriculum for Training in Pediatric Transplant 791
Danziger-Isakov et al.
Infectious Diseases (1) was developed to promote training in pediatric transplant infectious diseases. Current curriculum guidelines for North American training in pediatric ID do not delve deeply enough into either transplant-related specific ID knowledge or knowledge of transplant medicine and transplant-related systems to support the full potential of pediatric transplant ID. The suggested curriculum lays the foundation for training in pediatric transplant ID as an initial step to support the development of future specialists in this growing field. The need for more detailed knowledge of transplant-related infections balanced with knowledge outside of infectious diseases that is essential to the care of transplant recipients including transplant immunology, transplant systems, advocacy, and research are highlighted. Further initiatives to deepen pediatric transplant ID education have developed including the recent conference on Pediatric Transplant Infectious Diseases sponsored by the Pediatric Infectious Disease Society and St. Jude’s Children’s Hospital. However, future realization of the full potential of pediatric transplant ID will rely on thoughtful integration of transplant ID specialists into the fabric of both pretransplant and post-transplant care. The process for integration and final appearance of transplant ID has not been delineated, but opportunities to explore the potential are abundant across the entire transplant process from candidate and donor assessment to long-term post-transplant care and counseling to minimize infection-related morbidity. There are important secondary benefits of the above training. A very small minority of pediatric ID physicians focus solely on transplantation. Pediatric transplant ID specialists are used to dealing with specific immunomodulating agents and opportunistic infections; they are now approached for the care of other immunocompromised patient population in pediatrics, such as rheumatology and gastroenterology patients receiving immunomodulators. Outside of North America, there is an urgent need to integrate existing medical microbiologists, virologists, and ID specialists into the transplant teams more formally as partners in the care of these special patients. These individuals should be involved in the day to day management of transplant recipients from the time of transplant assessment and listing. These specialists should be empowered to implement agreed upon protocols and guidelines and evaluate the infection risk status of the patient at the time of transplant assessment, including immunization status, previous antibiotic 792
history, resistant organisms, and optimal antimicrobial plan. Furthermore, frequent input from the designated individual for the hospitalized patients should be organized. Specific skills unique to medical microbiologists, virologists, and ID specialists should be incorporated including but not limited to periodic audits on infectious complications, resistant organisms, and the use of antimicrobials. To develop additional expertise, formal training in transplant infectious diseases should be provided to the new trainees. Trainees should be expected to spend time in solid organ transplant centers. Medical microbiologists, virologists, or ID specialists should participate in research projects which can be triggered by ID or the other specialists. Depending on the size of the center, these collaborations can be centered on a specific organ or on transplantation in general. New opportunities to train pediatric ID physicians in transplant ID should be encouraged outside of North America as well, using societies, such as the European Society of Pediatric Infectious Diseases and the European Congress of Clinical Microbiology and Infectious Disease to promote sharing of specific knowledge. It could be envisioned that larger European centers also offer an additional period of training following the regular pediatric ID fellowship to emphasize pediatric transplantation. Improving education for non-ID practitioners within and outside North America
Given the important role that non-ID practitioners play in the management of transplantrelated infections in some settings, it is important to identify opportunities for these individuals to be equipped with the training that they need to function effectively. Even in centers in North America and Europe where pediatric transplant ID specialists are available, identification of potential transplant-related infections and opportunities for avoidance of or prophylaxis against such infections remain key roles of physicians and surgeons caring for transplant patients. It is thus vital that pediatric transplant ID forms a key component of the training curricula of these professionals. Given the complexity of transplant training and the many programs, institutions, and colleges governing such training worldwide, integration of appropriate and consistent ID training may be challenging. Outside of North America and Europe, there are many transplant programs that may be constrained by resources due either to small center
Capacity building in pediatric transplant ID
size, local economics, geographical isolation, or a combination of factors. In such areas, it may be unrealistic for there to be specific pediatric transplant ID physicians and the onus lies more strongly on transplant physicians and surgeons to be adequately trained in transplant ID. Nonetheless, opportunities exist for transplant professionals to partner with their counterparts working in pediatric ID at their institutions. It is vital that new transplant facilities engage their local pediatric ID service at an early stage to ensure that resource allocation to pediatric transplant ID is maximized. Pediatric ID professionals, even if not working exclusively in the area of transplantation, have expert knowledge of other groups of immunocompromised patients (e.g., children with primary immune deficiency, oncology patients, and children with gastroenterological and rheumatological disease). These professionals also have appreciation of specific infectious disease patterns in local childhood populations, which need to be considered in the design of infection prophylaxis and treatment protocols. Building capacity through shared engagement
The relationship between transplant physicians and ID specialists is therefore one of partnership, collaboration, and mutual continuing professional education. Ongoing skill development of both groups of caregivers is vital given the rapidly changing ID-specific knowledge within the field of pediatric transplantation. Relevant evidence-based guidelines and practice commit-
tee recommendations from transplant and ID societies such as those mentioned above can form the basis of local pediatric transplant ID practice. Other opportunities for education include regular joint journal clubs and in-hospital seminars and grand rounds. If resources for continued professional development are limited, then travel to overseas conferences can be averted by using novel educational techniques such as telemedicine or webinars offered by international transplant organizations. This is particularly relevant to small centers in poorly resourced areas for both education and assistance with complex clinical care. In addition, some centers may need to combine training in organ-specific transplantation with ID (pediatric or adult) or even microbiology. For those professionals training in pediatric transplantation that need to complete some of their training in overseas transplant programs, establishing durable relationships with larger centers that can provide a broad experience including pediatric transplant ID can prove worthwhile. Finally, bodies such as the ID Care Committee of IPTA may be able to play an advocacy role to begin to standardize the core knowledge for training such as those recently published as a collaborative effort (1). Reference 1. DANZIGER-ISAKOV L, ALLEN U, ENGLUND J, et al. Recommended curriculum for training in pediatric transplant infectious diseases. J Pediatric Infect Dis Soc 2013: doi:10.1093/jpids/ pit079.
793
Copyright of Pediatric Transplantation is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Pediatric Transplantation DOI: 10.1111/petr.12355
Capacity building in pediatric transplant infectious diseases: An international perspective Danziger-Isakov L, Evans HM, Green M, McCulloch M, Michaels MG, Posfay-Barbe KM, Verma A, Allen U: The ID CARE Committee from IPTA. (2014) Capacity building in pediatric transplant infectious diseases: An international perspective. Pediatr Transplant, 18: 790–793. DOI: 10.1111/petr.12355.
Lara Danziger-Isakov1, Helen M. Evans2, Michael Green3, Mignon McCulloch4, Marian G. Michaels3, Klara M. Posfay-Barbe5, Anita Verma6 and Upton Allen7: The ID CARE Committee from IPTA
Abstract: Transplant infectious diseases is a rapidly emerging subspecialty within pediatric infectious diseases reflecting the increasing volumes and complexity of this patient population. Incorporating transplant infectious diseases into the transplant process would provide an opportunity to improve clinical outcome and advocacy as well as expand research. The relationship between transplant physicians and infectious diseases (ID) specialists is one of partnership, collaboration, and mutual continuing professional education. The ID CARE Committee of the International Pediatric Transplant Association (IPTA) views the development and integration of transplant infectious diseases into pediatric transplant care as an international priority.
1
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA, 2Starship Children’s Hospital, Auckland, New Zealand, 3Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA, 4Red Cross War Memorial Children’s Hospital, Cape Town, South Africa, 5 Children’s Hospital of Geneva, University Hospitals of Geneva, Geneva, Switzerland, 6Department of Medical Microbiology, King’s College Hospital, London, UK, 7Hospital for Sick Children, University of Toronto, Toronto, ON, Canada Key words: Pediatric – transplant – infectious diseases – education Lara Danziger-Isakov, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229 USA Tel.: 513-636-7499 Fax: 513-636-7655 E-mail: [email protected] Accepted for publication 4 August 2014
Transplant infectious diseases (ID) is a rapidly emerging subspecialty within pediatric infectious diseases reflecting the increasing volumes and complexity of this patient population. While the interest in this specialized care for pediatric patients has grown, integration into transplant care teams is inconsistent. Incorporating transplant infectious diseases into the transplant process would provide an opportunity to improve clinical outcome and advocacy as well as expand research. Further, in areas where pediatric infectious diseases specialists are not available, the proposed educational tools will help to support other transplant specialists as well as foster relationships between infectious diseases and transplantation. The ID CARE Committee of the International Pediatric Transplant Association (IPTA) views the development and integration of transplant 790
infectious diseases into pediatric transplant care as an international priority. Training and care model for infectious disease in North America
The job activity profile defined as a “pediatric infectious diseases specialist” is well established in North America and serves as a template that guides the development of the pediatric transplant ID specialist. To this end, the involvement of pediatric transplant ID in North America has undergone a significant transition and expansion in the past several years. Increasing numbers of faculty positions focused on the care of immunocompromised hosts including solid organ and stem cell transplant recipients have become available indicating an appreciation for expertise in this realm, but immersion of these
Capacity building in pediatric transplant ID
practitioners in transplantation remains uneven across institutions. In part, this is due to inconsistent training within Pediatric ID Fellowship programs. While some centers have a long track record of providing these educational experiences, this is not universally the case. Accordingly, there is a need to expand and standardize training to gain special expertise in the management and prevention of infections in pediatric transplant recipients. Variability exists in all aspects of involvement of pediatric ID specialists, from engagement in ongoing clinical care outside of acute episodic illness to program development including IDrelated education and guidelines. Some institutions have developed ID service lines specifically directed at supporting transplantation, while others have integrated expertise in a more traditional model of inpatient care. The involvement of pediatric ID in North America has gone beyond interactions directed at specific patient questions to include interactions with the broader transplant community. Pediatric ID specialists with interest and expertise in solid organ transplantation more frequently participate in the transplant infrastructure. At the local and regional level, some pediatric ID specialists have developed relationships with their local organ procurement organizations (OPOs) to provide input and expertise in the assessment of potential donors. Others have taken on roles within the U.S.’s Organ Procurement and Transplant Network (OPTN) at both the regional level and within its ad hoc Disease Transmission Advisory Committee. There has been an increasing involvement of pediatric ID specialists in academic societies focusing on solid organ transplantation including the IPTA, American Society of Transplantation, and Transplantation Society. While this level of participation may be variable and highly individual dependent, it is clearly increasing. Participation in these organizations can foster the development of networks and mentoring, which should help to facilitate opportunities for collaborative research, quality improvement projects, and advocacy which currently remain undersubscribed. Training and care models for infectious disease outside of North America
The model of infectious diseases training that exists in North America differs from that which exists in some other regions of the world. In this regard, infectious diseases expertise is not necessarily delivered by an infectious diseases special-
ist as defined by North American credentials and training. Such care might be delivered by clinical microbiologists, virologists, and to some extent specialists in particular disciplines (such as nephrology, hepatology, and gastroenterology) as discussed further below. In addition, in some countries, the burden of infectious disease may be so substantial that most general pediatricians will have broad experience in infectious diseases. Many countries now offer a pediatric ID fellowship, but this is country-dependent. The requirements are often the same as for the adult ID curriculum, with the difference that basic training in pediatrics is mandatory. To our knowledge, no country offers a specific training in pediatric transplant ID, but care of transplant candidates and recipients is often mentioned in the program objectives. The model that currently exists in the United Kingdom exists in several regions of the world outside of North America, with medical microbiologist and virologists providing support to transplant teams. A fraction of hospitals have established pediatric ID departments, and the situation is further compromised by a lack of mandatory exposure of the trainees in the management of children with solid organ transplantation. The state of affairs is similar in the rest of Europe and Asia. In addition, adult teams mainly composed of transplant surgeons and physicians related to the organ specialty often provide pediatric care in solid organ transplantation due to colocation of pediatric services in adult hospitals. ID consultants are not always part of the transplant teams and as such are not involved in the day to day decision-making on ID management. Further, many centers have a comparatively low number of transplantations each year. Therefore, physicians interested in pediatric transplant ID often choose to train in North America. However, there is no traditional pathway to acquire experience. In the above context, given differences in the models of care offered by individuals delivering pediatric ID expertise to their respective transplant teams, it will be important to determine how best to adapt current training curricula to meet the needs of these individuals until such time when pediatric infectious training programs are more firmly established. Newly approved curriculum for North American training and application inside and outside of North America
The recently published Recommended Curriculum for Training in Pediatric Transplant 791
Danziger-Isakov et al.
Infectious Diseases (1) was developed to promote training in pediatric transplant infectious diseases. Current curriculum guidelines for North American training in pediatric ID do not delve deeply enough into either transplant-related specific ID knowledge or knowledge of transplant medicine and transplant-related systems to support the full potential of pediatric transplant ID. The suggested curriculum lays the foundation for training in pediatric transplant ID as an initial step to support the development of future specialists in this growing field. The need for more detailed knowledge of transplant-related infections balanced with knowledge outside of infectious diseases that is essential to the care of transplant recipients including transplant immunology, transplant systems, advocacy, and research are highlighted. Further initiatives to deepen pediatric transplant ID education have developed including the recent conference on Pediatric Transplant Infectious Diseases sponsored by the Pediatric Infectious Disease Society and St. Jude’s Children’s Hospital. However, future realization of the full potential of pediatric transplant ID will rely on thoughtful integration of transplant ID specialists into the fabric of both pretransplant and post-transplant care. The process for integration and final appearance of transplant ID has not been delineated, but opportunities to explore the potential are abundant across the entire transplant process from candidate and donor assessment to long-term post-transplant care and counseling to minimize infection-related morbidity. There are important secondary benefits of the above training. A very small minority of pediatric ID physicians focus solely on transplantation. Pediatric transplant ID specialists are used to dealing with specific immunomodulating agents and opportunistic infections; they are now approached for the care of other immunocompromised patient population in pediatrics, such as rheumatology and gastroenterology patients receiving immunomodulators. Outside of North America, there is an urgent need to integrate existing medical microbiologists, virologists, and ID specialists into the transplant teams more formally as partners in the care of these special patients. These individuals should be involved in the day to day management of transplant recipients from the time of transplant assessment and listing. These specialists should be empowered to implement agreed upon protocols and guidelines and evaluate the infection risk status of the patient at the time of transplant assessment, including immunization status, previous antibiotic 792
history, resistant organisms, and optimal antimicrobial plan. Furthermore, frequent input from the designated individual for the hospitalized patients should be organized. Specific skills unique to medical microbiologists, virologists, and ID specialists should be incorporated including but not limited to periodic audits on infectious complications, resistant organisms, and the use of antimicrobials. To develop additional expertise, formal training in transplant infectious diseases should be provided to the new trainees. Trainees should be expected to spend time in solid organ transplant centers. Medical microbiologists, virologists, or ID specialists should participate in research projects which can be triggered by ID or the other specialists. Depending on the size of the center, these collaborations can be centered on a specific organ or on transplantation in general. New opportunities to train pediatric ID physicians in transplant ID should be encouraged outside of North America as well, using societies, such as the European Society of Pediatric Infectious Diseases and the European Congress of Clinical Microbiology and Infectious Disease to promote sharing of specific knowledge. It could be envisioned that larger European centers also offer an additional period of training following the regular pediatric ID fellowship to emphasize pediatric transplantation. Improving education for non-ID practitioners within and outside North America
Given the important role that non-ID practitioners play in the management of transplantrelated infections in some settings, it is important to identify opportunities for these individuals to be equipped with the training that they need to function effectively. Even in centers in North America and Europe where pediatric transplant ID specialists are available, identification of potential transplant-related infections and opportunities for avoidance of or prophylaxis against such infections remain key roles of physicians and surgeons caring for transplant patients. It is thus vital that pediatric transplant ID forms a key component of the training curricula of these professionals. Given the complexity of transplant training and the many programs, institutions, and colleges governing such training worldwide, integration of appropriate and consistent ID training may be challenging. Outside of North America and Europe, there are many transplant programs that may be constrained by resources due either to small center
Capacity building in pediatric transplant ID
size, local economics, geographical isolation, or a combination of factors. In such areas, it may be unrealistic for there to be specific pediatric transplant ID physicians and the onus lies more strongly on transplant physicians and surgeons to be adequately trained in transplant ID. Nonetheless, opportunities exist for transplant professionals to partner with their counterparts working in pediatric ID at their institutions. It is vital that new transplant facilities engage their local pediatric ID service at an early stage to ensure that resource allocation to pediatric transplant ID is maximized. Pediatric ID professionals, even if not working exclusively in the area of transplantation, have expert knowledge of other groups of immunocompromised patients (e.g., children with primary immune deficiency, oncology patients, and children with gastroenterological and rheumatological disease). These professionals also have appreciation of specific infectious disease patterns in local childhood populations, which need to be considered in the design of infection prophylaxis and treatment protocols. Building capacity through shared engagement
The relationship between transplant physicians and ID specialists is therefore one of partnership, collaboration, and mutual continuing professional education. Ongoing skill development of both groups of caregivers is vital given the rapidly changing ID-specific knowledge within the field of pediatric transplantation. Relevant evidence-based guidelines and practice commit-
tee recommendations from transplant and ID societies such as those mentioned above can form the basis of local pediatric transplant ID practice. Other opportunities for education include regular joint journal clubs and in-hospital seminars and grand rounds. If resources for continued professional development are limited, then travel to overseas conferences can be averted by using novel educational techniques such as telemedicine or webinars offered by international transplant organizations. This is particularly relevant to small centers in poorly resourced areas for both education and assistance with complex clinical care. In addition, some centers may need to combine training in organ-specific transplantation with ID (pediatric or adult) or even microbiology. For those professionals training in pediatric transplantation that need to complete some of their training in overseas transplant programs, establishing durable relationships with larger centers that can provide a broad experience including pediatric transplant ID can prove worthwhile. Finally, bodies such as the ID Care Committee of IPTA may be able to play an advocacy role to begin to standardize the core knowledge for training such as those recently published as a collaborative effort (1). Reference 1. DANZIGER-ISAKOV L, ALLEN U, ENGLUND J, et al. Recommended curriculum for training in pediatric transplant infectious diseases. J Pediatric Infect Dis Soc 2013: doi:10.1093/jpids/ pit079.
793
Copyright of Pediatric Transplantation is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
