Neonatal acute myeloid leukemia in an infant whose mother was exposed to diethylstilboestrol in utero.

We report on an acute myeloid leukemia in a neonate whose mother was exposed to diethylstilboestrol in utero. The newborn presented with leukemia cutis, hemorrhagic skin lesions, hyperleucocytosis and disseminated intravascular coagulation. A bone marrow examination confirmed the diagnosis of acute monocytic leukemia with a t(11;19) MLL-ELL fusion transcript. Chemotherapy was initiated but the child developed a bilateral pulmonary infection that led to fatal respiratory distress. This case shows acute myeloid leukemia and the third pediatric leukemia reported after maternal diethylstilboestrol exposure.

Acute kidney injury in paediatric bone marrow patients.

Bone marrow transplantation (BMT) is a life-saving intervention that has changed the prognosis of a wide range of haemato-oncologic, immunological and metabolic diseases over the last decades. The incidence of both autologous and allogenic BMT exponentially increased in both the adult and paediatric populations since the 1980s. One of the most frequent complications of BMT is renal failure, with 5% to 15% of all BMT developing acute kidney injury (AKI) and 5% to 20% of the survivors developing chronic renal failure (CRF). From those patients, about 50% will require renal replacement therapy (RRT). Risk factors for BMT-associated AKI are numerous and the pathogenesis is usually complex. Primary diagnosis, drug toxicity, total body irradiation, preexisting kidney dysfunction, veno-occlusive disease, sepsis, relative dehydration, non HLA-identical-related or matched-unrelated donors are risk factors for AKI after BMT. As AKI has been recognized to be predictive of long-term kidney dysfunction, prompt recognition and control of the risk factors are crucial to avoid increased morbidity and mortality due to CRF. With the improvement of BMT techniques, a better recognition of risk factors and aggressive management, there appears to be a steady decline with time in the occurrence of both AKI and CRF.

The paediatric liver transplantation program at the Université catholique de Louvain.

The Paediatric Liver Transplant Program at Saint-Luc University Clinics constitutes a substantial single centre experience, including 667 transplantations performed between March 1984 and April 2003, and the history of this program reflects the tremendous progress in this field since twenty years. Liver transplantation in children constitutes a considerable undertaking and its results depend on multiple, intermingled risk factors. An analysis of the respective impact of several surgical and immunological parameters on patient/graft outcome and allograft rejection after paediatric liver transplantation showed a significant learning curve effect as well as the respective impact of pre-transplant diagnosis on survival and of primary immunosuppression on the rejection incidence. The introduction of living related liver transplantation in 1993 not only permitted to provide access to liver replacement in as many as 74% more candidate recipients, but also resulted in better graft survival and reduced retransplantation rate. The results of a recent pilot study suggest that steroid avoidance is not harmful, and could even be beneficial for paediatric liver recipients, particularly regarding growth, and that combining tacrolimus with basiliximab (anti-CD25 chimeric monoclonal antibody) for steroid substitution appears to constitute a safe alternative in this context. The long-term issues represent the main future challenges in the field, including the possibility of a full rehabilitation through immunosuppression withdrawal and tolerance induction, the development of adolescence transplant medicine, and the risk of early atherogenesis in the adulthood.