Pediatric Transplantation最新文献

{"title":"Correction to \"Early Response to Therapeutic Plasma Exchange as a Prognostic Indicator in Pediatric Liver Transplant Recipients with Early Allograft Dysfunction\".","authors":"","doi":"10.1111/petr.70440","DOIUrl":"10.1111/petr.70440","url":null,"abstract":"","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70440"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subcutaneous Alemtuzumab as Salvage Therapy for Acute Kidney Transplant Rejection Following Thymoglobulin Anaphylaxis: A Pediatric Case Report.","authors":"Kevin W O'Connor, Serena Bagnasco, Cozumel Pruette, Elizabeth Goswami, Olga Charnaya","doi":"10.1111/petr.70446","DOIUrl":"10.1111/petr.70446","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney allograft rejection is a significant cause of graft dysfunction in pediatric transplant recipients. Standard of care for moderate to severe acute T-cell-mediated rejection among pediatric transplant recipients includes lymphocyte-depleting agents such as rabbit anti-thymocyte globulin (rATG). However, intolerance to or contraindications to rATG may limit its use and necessitate alternative immunosuppressive strategies. Alemtuzumab, a humanized monoclonal antibody targeting CD52, induces profound depletion of T- and B- lymphocytes and has been used in the transplantation setting. However, data remain limited for pediatric rejection, and the precise role for alemtuzumab is not well defined.</p><p><strong>Case presentation: </strong>We report a 12-year-old male with end-stage kidney disease secondary to congenital renal dysplasia who underwent deceased donor kidney transplantation and presented 9 years post-transplant with acute allograft dysfunction. Evaluation revealed a rise in serum creatinine, subtherapeutic tacrolimus levels, and increased donor-specific antibodies. Kidney biopsy demonstrated Banff grade IIA T-cell-mediated rejection with features of antibody-mediated rejection. Initial treatment included high-dose corticosteroids and intravenous immunoglobulin. rATG therapy was initiated but discontinued due to anaphylaxis. The patient subsequently received a 30-mg dose of subcutaneous alemtuzumab, which was well tolerated. B- and T-lymphocyte populations were suppressed on flow cytometry analysis. Kidney function significantly improved, repeat biopsy showed marked improvement in tubulointerstitial inflammation, and graft function remained stable at follow-up.</p><p><strong>Conclusions: </strong>This case highlights the potential role of alemtuzumab as an alternative lymphocyte-depleting therapy for the treatment of acute rejection in pediatric kidney transplant recipients, particularly when rATG is contraindicated. Moreover, treatment with alemtuzumab may preclude the need for additional B-cell directed therapy in cases of mixed T-cell- and antibody-mediated rejection. Further studies are needed to better define its safety, efficacy, and optimal role in this population.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70446"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13522642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biological Mother-To-Child Living Donor Liver Transplantation: Early Vs. Late Postpartum Donation.","authors":"Jacqueline I Kim, Suhani S Patel, Lauren M Kucirka, Shivani S Bisen, Jennifer Vittorio, Adam Griesemer, Dorry L Segev, AnnMarie Liapakis, Allan B Massie","doi":"10.1111/petr.70449","DOIUrl":"10.1111/petr.70449","url":null,"abstract":"<p><strong>Introduction: </strong>Biological parental donations provide the best option for many pediatric recipients, yielding unique immunological benefits that may enable minimization of immunosuppression in transplanted children. However, living related maternal donation in the postpartum period may introduce an increased risk of donor complications due to the physiological changes of pregnancy and childbirth, and the optimal timing of postpartum living donation is unknown.</p><p><strong>Methods: </strong>Using US national registry data, we characterized donor and recipient outcomes for pediatric living donor liver transplants performed between 2004 and 2022 where a biological mother donated to a child ≤ 24 months old.</p><p><strong>Results: </strong>Our study population included 256 donor-recipient pairs, with biliary atresia representing the most common indication for transplantation (68.0%). Donors had a median [IQR] age of 30 [25, 34] years, and the median [IQR] time from birth to donation was 9.0 [6.8, 13.0] months. 6.3% of donors experienced a biliary or other complication. When stratifying by donors who donated ≤ 6 vs. > 6 months postpartum, we found no significant differences in donor complications or readmission. Stratified analyses were also comparable for recipient mortality, graft survival, and rejection-free survival. Donors ≤ 6 months postpartum (n = 64) were more likely to experience reoperation than mothers who donated > 6 months postpartum (n = 192) (6.2% vs. 1.0%, p = 0.04).</p><p><strong>Conclusions: </strong>While maternal living donor liver transplantation is safe for most donors, there is a higher risk of reoperation when donation is performed ≤ 6 months postpartum. Surgeons should be aware that these donors are a higher risk population, requiring discussion upon consent and warranting close post-operative monitoring.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70449"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Perioperative Management on Short-Term Renal Transplant Outcome: A Retrospective Cohort Study.","authors":"Nai-Wei Wang, Matthias Görges, Myles Cassidy, Tom Blydt-Hansen","doi":"10.1111/petr.70434","DOIUrl":"10.1111/petr.70434","url":null,"abstract":"<p><strong>Background: </strong>There are limited data on how intraoperative hemodynamic factors influence pediatric kidney transplant outcomes, particularly across the different phases of graft reperfusion. With the widespread introduction of anesthesia information management systems, new opportunities have emerged to explore how intraoperative management affects transplant outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study at a single center, including transplant recipients under 19 years of age who underwent kidney transplantation between 2010 and 2022 (n = 121). Data were extracted from chart reviews, anesthesia records, and an intraoperative monitoring databank. Modeling for clinical variables alone, intraoperative variables alone, and combined clinical-intraoperative features was analyzed with respect to three outcomes: Unadjusted glomerular filtration rate at one-month post-transplant (uGFR_1M), time to creatinine nadir, and length of hospital stay.</p><p><strong>Results: </strong>Longer duration of pre-unclamp mean arterial pressure (MAP) below the 95th percentile (β = -0.086, p = 0.009), a greater number of inotropes used during the pre-unclamp period (β = -4.00, p = 0.017), and higher MAP variability in the first 30 min post-unclamp (β = -1.38, p = 0.006) were each independently associated with lower uGFR_1M. A greater volume of fluid administered in the pre-unclamp period was independently associated with a longer time to creatinine nadir (β = 0.002, p = 0.01).</p><p><strong>Conclusions: </strong>Intraoperative features related to pre-unclamp volume resuscitation, MAP control, and post-unclamp hemodynamic instability are associated with slower graft function in pediatric kidney transplantation.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70434"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transmission of Anellovirus From Kidney-Donor to Pediatric Recipient: An Exploratory Study.","authors":"Luna S Klomp, Maarten G J M Burggraaff, Margreet Bakker, Michel Molier, Anne L Timmerman, Martin Deijs, Mariet Feltkamp, Lia van der Hoek, Antonia H M Bouts","doi":"10.1111/petr.70448","DOIUrl":"10.1111/petr.70448","url":null,"abstract":"<p><strong>Background: </strong>Among the most abundant viruses in the human blood virome are anelloviruses, including alpha-, beta-, and gammatorqueviruses (TTV, TTMV, and TTMDV). Whether anelloviruses are transmitted through kidney transplantation at a young age and subsequently persist in their new host is unknown. This study investigates the dynamics and composition of the anellome in the blood of six pediatric donor-recipient pairs, with monitoring beginning before transplantation and continuing until 2 years after transplantation.</p><p><strong>Methods: </strong>Donors were sampled once, before donation, while recipients were sampled before and multiple times after transplantation (median 6.5 samples). Quantitative PCR, rolling circle amplification, Illumina sequencing, and SCANellome V2 analysis were used to detect, characterize, and compare anellovirus presence in donors and recipients.</p><p><strong>Results: </strong>At baseline, four out of six donors tested positive for TTV by quantitative anellovirus PCR, three of whom had sufficient viral loads to enable genomic comparison with their recipients. All recipients tested positive at baseline, five had a moderate viral load (< 10⁵ copies/mL), and one had > 10⁹ copies of TTV DNA/mL. This recipient was already immunosuppressed before transplantation, and only in this recipient was a donor-derived anellovirus identified. This lineage was detected among 15 other lineages in the recipient and matched one of the four lineages identified in the donor.</p><p><strong>Conclusion: </strong>This finding demonstrates that anellovirus transmission from donor to recipient occurs in pediatric kidney transplantation. This may be associated with pre-existing immunosuppression.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70448"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proximal Roux-en-Y Limb Intussusception After Pediatric Living Donor Liver Transplantation for Biliary Atresia: A Rare Surgical Emergency.","authors":"Peng Cai, Seisuke Sakamoto, Hajime Uchida, Chanokkamol Kiataramkul, Ayane Oshiro, Masato Kojima, Ryuji Komine, Yusuke Yanagi, Akinari Fukuda, Mureo Kasahara","doi":"10.1111/petr.70439","DOIUrl":"10.1111/petr.70439","url":null,"abstract":"<p><strong>Background: </strong>Intussusception of the Roux-en-Y limb after pediatric liver transplantation (LT) is an extremely rare but potentially life-threatening complication. Altered anatomy, postoperative adhesions, and disrupted intestinal motility create a unique pathophysiological environment, which may delay diagnosis and increase morbidity.</p><p><strong>Methods: </strong>We retrospectively analyzed a patient with acute intestinal obstruction after living donor liver transplantation. Clinical presentation, laboratory findings, imaging results, intraoperative observations, surgical management, and outcomes were reviewed. The potential pathogenesis was explored in relation to factors such as Roux-en-Y reconstruction, graft-to-recipient size ratio, and postoperative adhesive disease.</p><p><strong>Results: </strong>The patient presented with fever and melena. Laboratory evaluation revealed leukocytosis and severe anemia. Computed tomography demonstrated small bowel intussusception with obstruction. Emergency laparotomy identified intussusception of the proximal Roux limb near the biliary-enteric anastomosis. Manual reduction was unsuccessful, necessitating segmental resection without reconstruction of a new Roux limb. Extensive intra-abdominal adhesions were noted. Postoperative recovery was uneventful, and graft function remained stable.</p><p><strong>Conclusions: </strong>Intussusception of the Roux-en-Y limb following pediatric living donor liver transplantation is a complex surgical emergency. This case demonstrates that in the transplant population, symptoms such as fever and melena should trigger immediate cross-sectional imaging to rule out mechanical obstruction. The management strategy must be aggressive yet conservative regarding anatomical disruption. As the population of long-term pediatric transplant survivors grows, recognizing these distinct mechanistic patterns is essential for reducing morbidity and mortality.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70439"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Well Do \"Dr. Google\" and \"Professor YouTube\" Answer Health Questions for Pediatric Kidney Transplant Recipients and Caregivers?","authors":"Ashley Burghall, Ryan R D Chan, Nicola Rosaasen, Tom D Blydt-Hansen, Laura Beresford, Allison Cammer, Keefe Davis, Kayla Flood, Aviva Goldberg, Lorraine Hamiwka, Kathryn Haubrich, Camille Laroche, Véronique Phan, Michelle Ruhl, Chia Wei Teoh, Jenny Wichart, Holly Mansell","doi":"10.1111/petr.70409","DOIUrl":"10.1111/petr.70409","url":null,"abstract":"<p><strong>Background: </strong>Pediatric kidney transplant recipients and their caregivers require comprehensive education to support self-management. Increasingly, families supplement clinic teaching with online platforms such as Google and YouTube, yet the quality, readability, and usefulness of these resources are uncertain.</p><p><strong>Methods: </strong>Structured searches on Google and YouTube were conducted using patient-style questions and medically oriented key terms across four prioritized topics: healthy eating, exercise, travel, and mental health. Resources were screened for relevance and assessed for accuracy, completeness (defined as including all key facts needed to support recommendations), readability, and actionability (defined as providing clear, practical steps users can follow). Two pediatric transplant healthcare providers independently reviewed each resource. Two researchers assessed understandability and actionability using the Patient Education Materials Assessment Tool (PEMAT), and readability using multiple readability tools.</p><p><strong>Results: </strong>Searches yielded 87 Google and 41 YouTube resources; most targeted adult transplant recipients. Healthcare providers assessed 65% of Google and 68% of YouTube resources to be accurate, but only 18% and 5% were factually complete. Actionable recommendations were identified in 42% (Google) and 29% (YouTube). Readability ranged from grade 5 to 17, with only 6 of 82 Google resources meeting the recommended grade 6 or lower. Mean understandability scores were 67% for both platforms. Actionability scores averaged 39% (Google) and 77% (YouTube). Resources suitable for pediatric audiences (n = 28) had similar readability and understandability scores but slightly higher actionability (Google: 43%, YouTube: 81%). Most resources lacked pediatric focus, co-creation, and practical guidance.</p><p><strong>Conclusions: </strong>Online searches generated limited high-quality resources tailored to pediatric needs. Healthcare providers should guide families to vetted resources and consider co-creating materials to improve relevance and impact.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70409"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alemtuzumab Induction via Intravenous vs. Subcutaneous Administration in Pediatric Kidney Transplantation.","authors":"H Pizzo, A Barbera, K Westreich, M E Seifert, J Mirocha, K Kirshner, D Puliyanda","doi":"10.1111/petr.70424","DOIUrl":"10.1111/petr.70424","url":null,"abstract":"<p><strong>Background: </strong>Alemtuzumab is an induction immunosuppressive agent effective in preventing hyperacute rejection; however, it can result in prolonged lymphocyte depletion. Here we assessed the dosing, tolerability, and outcomes with alemtuzumab induction via IV vs. SQ route in pediatric kidney transplantation.</p><p><strong>Methods: </strong>A multicenter analysis of 119 patients < 21 years old who received alemtuzumab induction immunosuppression. Total dose (mg) and dose by body weight (mg/kg) were assessed. Tolerability was defined by the development of leukopenia (WBC < 3.0 × 10³/uL) or neutropenia (ANC < 1.5 × 10³/uL). Outcomes in the first year post-transplant were defined by eGFR, hospitalizations, infections, development of de novo DSA, and rejection.</p><p><strong>Results: </strong>A total of 83 and 36 recipients received alemtuzumab IV and SQ, respectively. SQ group was slightly older, 14.0 y. (SD 5.5) vs. 11.9 y. (SD 6.1) (p = 0.07), and had more highly sensitized recipients, 14 (38.9%) vs. 10 (12.1%) (p = 0.002). Total dose and dose by weight were higher in the SQ group, 22.3 mg (SD 8.9) vs. 14.9 mg (SD 9.5), and 0.57 mg/kg (SD 0.21) vs. 0.36 mg/kg (SD 0.18 mg), respectively (p = 0.0001 and p < 0.0001). SQ group experienced more leukopenia and resultant medication dose reduction; however, there were no differences between the groups in eGFR, infections, hospitalizations, and rejection in the year following transplant.</p><p><strong>Conclusion: </strong>Despite the higher dose of alemtuzumab and rates of leukopenia in the SQ group, there were no other differences in tolerability and outcomes compared to IV alemtuzumab. Overall, alemtuzumab is well tolerated during the first year post-transplant as an induction immunosuppression agent in the pediatric population.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70424"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13469996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventional Radiology Management After Early Hepatic Artery Thrombosis Following Pediatric Liver Transplantation.","authors":"Mercadal-Hally Maria, Pérez Mercedes, Molino José Andrés, Barnés Daniel, Caralt Mireia, Dalmau Mar, Díez Iratxe, Dopazo Cristina, Gómez-Gavara Concepción, González Carla, Juamperez Javier, Mameli Simone, Miserachs Mar, Muyo Paula, Ortega Juan, Padrós Cristina, Sapisochin Gonzalo, Hidalgo Ernest, Quintero Jesús","doi":"10.1111/petr.70423","DOIUrl":"https://doi.org/10.1111/petr.70423","url":null,"abstract":"<p><strong>Background: </strong>Hepatic artery complications are a major cause of early graft loss after liver transplantation (LT), especially in pediatric patients. Traditionally, these complications have been managed with surgical reintervention. This study presents the outcomes of early radiological intervention in pediatric LT patients with early hepatic artery thrombosis (HAT).</p><p><strong>Methods: </strong>A retrospective analysis was conducted by reviewing the prospectively collected database in our center. Patients between 0 to 18 years of age who had received an LT between 2003 and 2024 and had presented HAT in the first month after LT were included.</p><p><strong>Results: </strong>Out of 340 LTs, 13 patients (3.8%) presented early HAT and underwent an interventional radiology procedure (IRP) with balloon dilation and local infusion of vasodilators and/or fibrinolytic drugs. Five patients also required stent placement. The median time from LT to IRP was 1 day (0-6.5). IRP primary technical success was achieved in 11 of 13 patients (84.6%). Hepatic artery patency at three months was achieved in 10/13 (76.9%) of our patients, whilst long-term hepatic artery patency was achieved in 8/13 (61.5%) patients. Two patients ultimately required retransplantation.</p><p><strong>Conclusions: </strong>An early and proactive interventional radiology approach may represent a feasible option for managing early HAT after pediatric LT. When performed promptly after diagnosis, it can help preserve hepatic artery patency and potentially reduce the need for surgical intervention and retransplantation.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70423"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Living Donor Liver Transplantation in Pediatric Situs Inversus: A Case Series and Systematic Review.","authors":"Maria F Fernandez, Nadia Ali, Carolina Rumbo, Piyush Gupta, Kathryn LaRusso, Nada Yazigi, Christof Kaltenmeier, Juan F Guerra, Leonardo A Montes, Udeme Ekong, Alexander Kroemer, Dolores Garcia-Hervas, Khalid Khan, Yuri Genyk, Cal Matsumoto, Julio Trentadue, Diego Ramisch, Pablo Barros-Schelotto, Thomas Fishbein, Gabriel E Gondolesi","doi":"10.1111/petr.70425","DOIUrl":"10.1111/petr.70425","url":null,"abstract":"<p><p>Liver transplantation (LT) in patients with situs inversus (S-I) is rare and technically challenging. The literature on such cases, particularly in pediatric populations, remains limited. Here, we report the surgical considerations and outcomes of two pediatric recipients with situs inversus abdominalis who underwent liver transplantation for biliary atresia (BA). We conducted a retrospective descriptive analysis of two pediatric patients with S-I who underwent LT for BA. Pretransplant imaging, intraoperative details, and posttransplant outcomes were evaluated. Additionally, we performed a systematic review of the literature on LT in patients with S-I. We describe the successful living donor liver transplantation (LDLT) of two pediatric patients with S-I abdominalis and BA, each presenting with complex anatomical variations, including polysplenia, intestinal malrotation, and vascular anomalies such as absence of the inferior vena cava (IVC). Both patients underwent technically demanding procedures requiring customized vascular and biliary reconstructions, along with definitive correction of intestinal malrotation to restore anatomical intestinal orientation. Both patients had an uncomplicated immediate postoperative course. During follow-up, one patient developed a diaphragmatic hernia that required surgical repair. Our systematic review confirms that, although rare, pediatric LT in patients with S-I is increasingly reported with favorable outcomes. These findings support the feasibility and safety of LT in children with S-I when guided by meticulous preoperative planning and intraoperative adaptability. Liver transplantation in pediatric patients with S-I is feasible and can be performed safely with careful preoperative planning and tailored surgical techniques. Our experience, together with the available literature, supports the inclusion of these patients as suitable candidates for transplantation despite their complex anatomy.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70425"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}