The Duke Pediatric Immunocompromised Host Program (DPIHP) is a multi-disciplinary, integrated clinical and research program that functionally links the care and advancement of immunocompromised children at Duke.

The DPIHP spans the Departments of Pediatrics and Surgery, purposefully integrating the medical and surgical approaches to the patient in the specialty areas of solid organ transplant (liver, intestine, kidney and heart), bone marrow transplant, oncology, immunology and rheumatology. 

The DPIHP is the nation’s only comprehensive pediatric program of this nature. In addition, this is the first time a formal association between such a wide range of caregivers and researchers all focused on immunocompromised patients has ever been officially established at Duke. 

There are three major pillars of the Duke Pediatric Immunocompromised Host Program are Clinical, Research, and Education.  

Pediatric medicine is rapidly advancing with new cures for childhood cancers and autoimmune diseases, and expanding indications for organ and stem cell transplantation that were previously never thought possible. Many forms of pediatric cancer are now more curable, musculoskeletal and joint disease in children is now more manageable, children who used to die are now receiving new organs, and devastating inherited diseases are being eradicated through bone marrow transplantation. All of these advances, however, come at a formidable cost—suppression of the immune system. When the immune system is removed or inhibited, infection is a leading cause of mortality and morbidity. Even with modern medical discoveries, our understanding of infections in children with suppressed immune systems is far behind and consistently hindering improved overall outcomes. Too many children have won their battle, only to lose the war to an infection. 

There is a myriad of organizations, foundations, and research centers dedicated to the fundamental searches for improved treatments for cancer, transplantation, and autoimmune disease. What consistently links each of these endeavors are the serious adverse effects of all of their progress – immunosuppression leading to infection. Unfortunately, despite this growing trend, there is not a single program in the nation linking all of these children with different underlying diseases by focusing on the infections that immunocompromised patients all develop, and to which many succumb.  

The Duke Pediatric Immunocompromised Host Program (DPIHP) focuses on answering questions such as:

• Why do children with different immunocompromised conditions develop specific infections?
• How can they be prevented and diagnosed in subpopulations of patients?
• How can novel therapies be advanced in different groups of children who are linked through their immunosuppression?

The DPIHP is unique as the nation’s only multi-disciplinary program with this focus, spanning the Departments of Pediatrics and Surgery to include providers who care for children in the specialty areas of solid organ transplant (liver, intestine, kidney and heart), bone marrow transplant, oncology, immunology and rheumatology. 

The scope of the problem is large and ever-growing. A single investigator cannot solve these substantial problems, as decades of this silo approach have yielded few advances. What is needed is a paradigm shift in thinking toward a collaborative effort. There needs to be a joint venture to tackle the unified threat, coordination amongst infectious diseases, bone marrow transplantation, organ transplantation, oncology, rheumatology and others to bring about historic improvements in outcome that parents and patients can believe. This problem connects all of these pediatric fields, so the solution has to transcend them as well. Improved therapies for cancer and autoimmunity are the start, and innovative techniques to place new organs in failing bodies are the beginning. But after the chemotherapy infuses and the surgical sutures are placed, the real battle for survival from the needed immunosuppression begins.

The overall mission of the Duke Pediatric Immunocompromised Host Program (DPIHP) is to provide outstanding coordinated patient care coupled with translational research directly linked to clinical advances to achieve optimal health for patients with compromised immune function.

In support of our overarching mission, the program's goals are:

• Integrated co-management with a multidisciplinary approach toward care
• Innovative clinical studies to advance newer pediatric-focused strategies to improve outcomes of immunocompromised children
• Molecular research to understand the fundamental basis of infections in immunocompromised children (e.g., disease pathogenesis, biomarkers)
• Training for a new generation of physicians and scientists to continue advance this growing field
• Education and support for both parents and patients about these often unrealized infectious challenges and what they can do to partner to help fight the battle.

Integrated clinical co-management. Patients with a suppressed immune system are often managed by multiple specialties, and paramount to improving outcomes is coordinated co-management by the team through dedicated joint conferences and shared clinics. The DPIHP serves as that central connection for providers to optimize clinical care. 

Clinical studies. Another hallmark to real medical progress is collaboration, as clinical research that benefits all children cannot be realistically accomplished at one hospital. The DPIHP serves as the coordinating center for clinical research focusing on infections in highly immunocompromised children. This unifies those investigators who have contributed in small ways over the past decades to the field, and embolden them through larger numbers and opportunities. This effort also places Duke on the forefront of this effort – tackling this growing issue with a novel approach.  

Molecular research. The fundamental premise of successful biomedical advances is dedicated laboratory investigation to uncover the next significant insights. Those insights fuel new innovation and new discovery that directly benefits patients. The DPIHP will competitively award grants to stellar Duke laboratories focusing on infections that directly affect children with a limited immune system. This mechanism will encourage and drive laboratories with top-notch scientific insight to enter the fight against infections in immunocompromised patients, bringing new forces to the battle. Encouraging novel collaborations to analyze problems creatively is the future of discovery. Bolstering existing laboratories doing great work in other fields to fight against infection and adding newer partnerships will create a never before achieved effort for real progress.

Innovative training. The problem of infections in immunocompromised children is growing, and the current workforce of physicians and scientists is not equipped to tackle these issues. The DPIHP will facilitate individual physicians and scientists dedicated to this work, expanding the pool of future resources and purposefully driving more talented young investigators into this exciting field.

Patient education. Time and time again families yearn for more understanding of what is happening to their child. There is a myriad of brochures, websites, and support groups for childhood cancer or other debilitating illnesses, but for those countless families where their child is battling survival against a deadly infection, there is little to turn to for knowledge or comfort. To aid these families, the DPIHP will develop supportive information in the form of pamphlets and websites in direct partnership with patient and family-driven groups about these infections and what families can do to prevent and aid in the treatment of infections when they develop. 

All of the resources being dedicated to improved treatments for cancer, transplantation and autoimmune disease are for naught if a child is unable to recover from severe and often deadly infections. The scope of this problem is large and ever-growing and will require a paradigm shift in thinking to address. Duke Children’s operates the nation’s first joint venture to tackle the unified threat—coordination amongst infectious diseases, bone marrow transplantation, organ transplantation, oncology, rheumatology and others to bring about historic improvements in outcome.