Pediatric Transplantation最新文献

{"title":"Back-Table Reduction of a Deceased Adult Donor Kidney for Transplantation Into a Small Child: A Six-Year Follow Up.","authors":"Kaabak Michael, Rappoport Nadeen, Gardashnik Rozanna, Avetisov Evgeny, Platova Elena","doi":"10.1111/petr.70468","DOIUrl":"10.1111/petr.70468","url":null,"abstract":"<p><strong>Background: </strong>Transplantation of adult-sized kidneys into very small pediatric recipients can be limited by pronounced donor-recipient size mismatch. Although intraperitoneal placement is often considered, extraperitoneal implantation may reduce abdominal morbidity, provided that the graft can be accommodated safely.</p><p><strong>Case presentation: </strong>We report transplantation of a left kidney from a 46-year-old deceased adult donor into a 15-month-old boy weighing 8.5 kg with congenital nephrotic syndrome and previous bilateral nephrectomy. The 14-cm graft had three arteries of comparable caliber. Because the right retroperitoneal space was insufficient to accommodate the graft, the upper pole, supplied by an independent polar artery, was resected ex vivo on the back table, reducing the graft volume by approximately one-third. The remnant kidney was implanted extraperitoneally with venous anastomosis to the inferior vena cava and two arterial anastomoses to the aorta.</p><p><strong>Outcome: </strong>Immediate graft function was excellent. Serum creatinine returned to normal within 24 h and surveillance biopsies at 1 month, 1, 3 , and 5 years showed preserved renal architecture. At 6-year follow-up, the child measured 116 cm, weighed 16 kg, had blood pressure of 90/60 mmHg, serum creatinine of 0.66 mg/dL, and a urine protein-creatinine ratio of 0.26 g/g while receiving mycophenolate monotherapy.</p><p><strong>Conclusion: </strong>In carefully selected circumstances, back-table reduction of a deceased adult donor kidney may be a technically feasible strategy to overcome extreme donor-recipient size mismatch in pediatric kidney transplantation without compromising medium-term graft structure or function.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70468"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Nurse as an Early Warning System: A Longitudinal Surveillance Model in Pediatric Transplantation.","authors":"João Daniel de Souza Menezes, Matheus Querino da Silva, Emerson Roberto Dos Santos, Mikaell Alexandre Gouvea Faria, Júlio César André, Rita de Cássia Helú Mendonça Ribeiro","doi":"10.1111/petr.70489","DOIUrl":"10.1111/petr.70489","url":null,"abstract":"<p><p>Posttransplant complications in pediatric patients, including rejection, infection, drug toxicity, and nonadherence, are still frequently identified at a late stage, when biomarkers have already changed and clinically meaningful harm to the graft or the patient may already be established. Current follow-up models remain overly dependent on laboratory tests, episodic visits, and reactive responses to overt deterioration, while underrecognizing subtle clinical signals perceived by nurses and caregivers over time. This viewpoint proposes the Nurse-as-Sensor Framework, in which nurses act as clinical sensors capable of detecting early \"soft signals,\" and operationalizes it through a Longitudinal Nursing Surveillance Model, combining structured nursing consultations, remote microcontacts, a brief standardized checklist, a dynamic risk score, and graduated response pathways. We argue that this model can be implemented immediately with simple resources, increase screening sensitivity, accelerate diagnostic workup, and strengthen nursing autonomy in pediatric posttransplant care.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70489"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149736","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":"Information Seeking and Engagement on Social Media Among Pediatric Solid Organ Transplant Recipients and Their Families.","authors":"Irene Chen, Christopher Yu, Julie M Robillard, Tom Blydt-Hansen","doi":"10.1111/petr.70480","DOIUrl":"10.1111/petr.70480","url":null,"abstract":"<p><strong>Background: </strong>Social media is widely used among adolescents and offers unique opportunities to support children with chronic illnesses. However, little is known about how pediatric solid organ transplant (SOT) recipients and their families engage with these platforms. The objectives of this study are to characterize how this population seeks and shares information and engages with other pediatric SOT recipients and their families or general members on a transplant-specific online group.</p><p><strong>Methods: </strong>We conducted a comprehensive search of the Reddit group, r/transplant. Publicly available posts and comments were included if they contained a self-identification as a pediatric SOT recipient (0-24 years old) or a family member. An inductive content analysis was performed to identify key topics. Self-disclosed demographic information was used to explore differences in discussion topics and engagement.</p><p><strong>Results: </strong>A total of 357 posts and 5827 comments met inclusion criteria. Users most commonly discussed medical symptoms, medication, social support, healthcare experiences, and post-transplant recovery. Family members predominantly focused on medical issues, while recipients addressed a broader range of topics. Topics users engaged with varied by time since transplant: recipients 0-4 years post-transplant frequently discussed emotional and medical challenges, while those 5+ years post-transplant posted more about celebrating milestones.</p><p><strong>Conclusions: </strong>Pediatric SOT recipients and their families use social media to seek and share information. Engagement patterns differ between recipients and their family members and across years post-transplant, suggesting the potential for tailored online interventions to support evolving needs across the transplant journey.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70480"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13650169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138041","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":"Fulminant Synchronous Epstein-Barr Virus-Positive MALT Lymphoma and Diffuse Large B-Cell Lymphoma Monomorphic Post-Transplant Lymphoproliferative Disorder in a Child Following Heart Transplant: A Case Report.","authors":"Anna J Elias, Daniel P Larson, Rebecca K Ameduri, Paul J Galardy","doi":"10.1111/petr.70452","DOIUrl":"10.1111/petr.70452","url":null,"abstract":"<p><strong>Background: </strong>Post-transplant lymphoproliferative disorder (PTLD) is a devastating complication following solid-organ and hematopoietic stem cell transplantation. While PTLD is often effectively managed with immunotherapy or immuno-chemotherapy, rare cases present in a fulminant manner and are rapidly life-threatening.</p><p><strong>Methods: </strong>We describe a case of an Epstein-Barr virus (EBV)-negative 16-year-old who developed EBV DNAemia and rapidly fulminant monomorphic PTLD within five months of receiving a heart transplant from an EBV-positive donor.</p><p><strong>Results/important clinical findings: </strong>Three months after transplant the patient developed EBV DNAemia, cytopenias, and severe gastrointestinal symptoms that led to the diagnosis of monomorphic PTLD, EBV-positive extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). The patient underwent immunotherapy, followed by two different immuno-chemotherapy regimens, none of which slowed the rapid progression of the disease. One month after the initial diagnosis, a repeat biopsy revealed the emergence of a distinct monomorphic PTLD, EBV-positive diffuse large B-cell lymphoma (DLBCL). The patient died of disease 10 weeks after diagnosis.</p><p><strong>Conclusions: </strong>The case exemplifies a fulminant case of EBV-positive MALT lymphoma as a form of monomorphic PTLD in a child. The case illustrates that MALT lymphoma may have an aggressive natural history, and the apparent rapid emergence of a distinct form of PTLD reinforces the need for repeat tissue sampling upon disease relapse or when the clinical behavior does not match the expectation.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70452"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Morbidity and Survival After Left Lateral Segment Versus Whole Liver Graft Transplantation in Children.","authors":"Helena Linge, Eva-Doreen Pfister, Vanessa Muth, Sahar Arbabzadah, Jan Forner, Teresa Linge, Nicolas Richter, Markus Quante, Tung-Yu Tsui, Ulrich Baumann, Moritz Schmelzle, Philipp Felgendreff, Cornelius J Van Beekum","doi":"10.1111/petr.70501","DOIUrl":"10.1111/petr.70501","url":null,"abstract":"<p><strong>Background: </strong>Left lateral segment (LLS) grafts expand graft availability for infants and small children requiring liver transplantation (LT). However, their cumulative early postoperative burden compared with whole liver grafts (WLGs) remains incompletely characterized.</p><p><strong>Methods: </strong>This retrospective single-center cohort study included 95 consecutive primary pediatric LT recipients treated between 2019 and 2024, comprising 56 LLS and 39 WLG recipients. Cumulative postoperative morbidity within 90 days was quantified using the Comprehensive Complication Index (CCI). Additional outcomes included biliary and vascular complications, unplanned surgical reinterventions, length of stay, graft loss, retransplantation, and graft and patient survival.</p><p><strong>Results: </strong>LLS recipients were younger and smaller than WLG recipients. Cumulative 90-day morbidity was greater after LLS transplantation (median CCI 53 vs. 45, p = 0.002). LLS recipients had higher rates of bile leakage (18% vs. 3%, p = 0.024), intra-abdominal bleeding (15% vs. 0%, p = 0.019), and unplanned surgical reintervention (43% vs. 8%, p < 0.001). Although the overall incidence of biliary complications was similar between groups, anastomotic biliary strictures during follow-up were more frequent after WLG transplantation (28% vs. 9%, p = 0.014). Hospital stay was longer after LLS transplantation (median 43 vs. 27 days, p < 0.001). No statistically significant differences in graft loss, retransplantation, or graft and patient survival were detected between groups.</p><p><strong>Conclusions: </strong>LLS transplantation was associated with greater cumulative morbidity within 90 days, characterized by higher rates of bile leakage, intra-abdominal bleeding, unplanned surgical reintervention, and prolonged hospitalization. Despite this greater early postoperative burden, no statistically significant differences in graft loss, retransplantation, or graft and patient survival were detected during the available follow-up. These findings support continued use of LLS grafts to expand transplant access. Given the associated early morbidity, it highlights the importance of an experienced surgical and medical team.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70501"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13681243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228647","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":"Letermovir Prophylaxis in Pediatric Allogeneic Hematopoietic Stem Cell Transplantation: Clinical Effectiveness and Economic Implications.","authors":"Swathi P M, Archana M V, Nishanth S, Emine A Rahiman, Nikitha K Nekkileru, Sudheesh N, Shivdas Rajaram Naik, Vasudeva K Bhat","doi":"10.1111/petr.70485","DOIUrl":"https://doi.org/10.1111/petr.70485","url":null,"abstract":"<p><strong>Background: </strong>Cytomegalovirus (CMV) reactivation is a major infectious complication following pediatric allogeneic hematopoietic stem cell transplantation (HSCT), particularly in low- and middle-income countries (LMICs) with high CMV seroprevalence. Data on the clinical and economic impact of letermovir prophylaxis in pediatric HSCT recipients from resource-constrained settings remain limited.</p><p><strong>Methods: </strong>We conducted a retrospective cost-effectiveness analysis of pediatric allogeneic HSCT recipients at a university-affiliated tertiary-care transplant center in India. Clinical outcomes and direct medical costs were compared between patients who received letermovir prophylaxis and those managed with a standard pre-emptive CMV strategy. The primary outcome was CMV reactivation by Day +100 post-transplant. Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio (ICER).</p><p><strong>Results: </strong>Fifty patients were included, of whom 15 received letermovir prophylaxis and 35 received standard pre-emptive management. By Day +100 post-transplant, CMV reactivation occurred in 26.7% of patients receiving letermovir compared with 91.4% in the non-letermovir group (p < 0.001). Median time to CMV reactivation was longer in the letermovir group at 28.5 days versus 18.0 days. No patient in the letermovir group required additional CMV-related hospitalization, whereas 50% of patients in the non-letermovir group required prolonged hospitalization. Mean total treatment costs were higher in the letermovir group at $1868.5 compared with $1698.6 in the non-letermovir group; however, the incremental cost-effectiveness ratio was $262.6 per additional patient without CMV reactivation.</p><p><strong>Conclusions: </strong>Despite higher upfront costs, letermovir demonstrated favorable cost-effectiveness in pediatric allogeneic HSCT recipients in resource-limited settings, while providing significant clinical benefits through reduced CMV reactivation, delayed breakthrough infection, and decreased CMV-related hospitalization.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70485"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sequential Versus Combined Liver-Kidney Transplantation in Pediatric Primary Hyperoxaluria Type 1: A Multi-Center Comparative Cohort Analysis.","authors":"Ryuji Komine, Jagadeesh Menon Vr, Hyun Hwa Choi, Kang-Wong Lee, Toru Ikegami, Yuji Soejima, Mureo Kasahara","doi":"10.1111/petr.70484","DOIUrl":"10.1111/petr.70484","url":null,"abstract":"<p><strong>Background: </strong>Combined liver-kidney transplantation is the standard treatment for pediatric primary hyperoxaluria Type 1 with advanced kidney disease, but sequential liver-kidney transplantation is increasingly used where living-donor transplantation predominates. Direct comparisons between these strategies remain limited.</p><p><strong>Methods: </strong>We retrospectively analyzed 19 pediatric patients with chronic kidney disease Stage 4 or higher who completed combined (n = 10) or sequential (n = 9) liver-kidney transplantation for primary hyperoxaluria Type 1 across four countries. The comparative analysis was restricted to patients who received both organs; patients who underwent liver transplantation without subsequent kidney transplantation were excluded.</p><p><strong>Results: </strong>Patients who completed sequential transplantation had earlier onset of primary hyperoxaluria Type 1-related symptoms (3.0 vs. 12.0 months, p = 0.029) and lower estimated glomerular filtration rate at liver transplantation (16.5 vs. 36.5 mL/min/1.73 m², p = 0.043) than those who completed combined transplantation. Among recipients who completed both procedures, major perioperative complications and patient survival did not differ significantly; no perioperative deaths occurred after the liver transplantation stage among patients who subsequently completed sequential transplantation. Death-censored kidney graft survival was higher in the completed-sequential group (log-rank p = 0.045). Among patients who completed sequential transplantation, an interval exceeding 6 months between liver and kidney transplantation showed a descriptive trend toward better preserved kidney function.</p><p><strong>Conclusions: </strong>Among pediatric patients with primary hyperoxaluria Type 1 who completed both liver and kidney transplantation, sequential transplantation was associated with favorable observed kidney graft outcomes. These findings describe outcomes among recipients who completed both procedures and should not be interpreted as outcomes of an initially intended sequential strategy.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70484"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vampire Problems in Pediatric Kidney Transplantation-Navigating Transformative Experiences and Informed Consent.","authors":"Vanessa Thiel, Aviva Goldberg","doi":"10.1111/petr.70477","DOIUrl":"10.1111/petr.70477","url":null,"abstract":"<p><p>There are clear legal and ethical requirements for informed consent in pediatric kidney transplantation. While much is done pre-transplant to educate patients and families on the risks and benefits of transplantation and its associated medical therapies, it can be difficult to truly prepare them for the transformative nature of the transplant- how it will change their lives, their families' lives, and their view of themselves and their world. Using the lens of \"transformative experiences\" as described by philosopher L.A. Paul, we describe the transformative nature of pediatric kidney transplantation. We encourage the health care team to acknowledge this transformative experience, and outline practical strategies including shared decision making and patient and family engagement to help communicate with families undergoing this transformation, both before and after pediatric kidney transplantation.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70477"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081797","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":"Exceptions in Pediatric Heart Transplantation: Are We Prioritizing the Right Patients?","authors":"Muhammad Abdullah Shaikh, Muhammad Faateh, Javeria Tariq, Hosam F Ahmed, Clifford Chin, David Morales, David Lehenbauer, Awais Ashfaq","doi":"10.1111/petr.70475","DOIUrl":"https://doi.org/10.1111/petr.70475","url":null,"abstract":"<p><strong>Background: </strong>In 2018, UNOS changed policies, altering organ distribution patterns. We compare survival in 1A patients with and without exceptions after these policy changes.</p><p><strong>Methods: </strong>Using UNOS, we included Status 1A patients (< 18 years of age) listed for a heart transplant from 2018 to 2025 and categorized them by exception status. Primary outcomes were survival from listing and post-transplant survival. Multivariable Cox regression assessed the independent association between exception status and survival, with a sub-analysis restricted to non-VAD patients.</p><p><strong>Results: </strong>Of the 3993 patients, 835 (21%) were listed by exceptions. Exception patients were older (7 vs. 2 years, p < 0.001), less often congenital heart disease (CHD) (19% vs. 65%, p < 0.001), and less often on ECMO, VAD, or ventilator support at listing (all p < 0.001). Exception patients had lower waitlist mortality (3.5% vs. 9.8%, p < 0.001), improved survival from listing (log-rank p < 0.0001), and improved post-transplant survival (log-rank p < 0.05). After adjustment for age, diagnosis, and pretransplant mechanical and ventilatory support, exception status was associated with superior survival from waitlist (HR 0.760, 95% CI 0.597-0.968, p = 0.026). In the sub analysis of patients who were not on VAD, exception status shows a trend toward improved waitlist survival (HR 0.843, 95% CI 0.652-1.09, p = 0.19).</p><p><strong>Conclusions: </strong>Status 1A exception patients have improved waitlist and unadjusted post-transplant survival as compared to standard criteria patients, and are, on average, less acutely ill at listings. These findings highlight heterogeneity within Status 1A and suggest an opportunity to incorporate objective acuity measures into exception review.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70475"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"I Think It's Institutional Racism:\" Pediatric Social Workers' Explanations of Racial Disparities in Kidney Transplant Access for Black Children in the United States.","authors":"Kristin L Stockard, Chelsea K Brown, Teri Browne, Tamara J Cadet","doi":"10.1111/petr.70492","DOIUrl":"10.1111/petr.70492","url":null,"abstract":"<p><strong>Background: </strong>Black children in the US with ESKD experience higher mortality, lower transplant rates, and longer time on dialysis than other children. Prior research on health disparities in adult kidney patients often emphasizes patient-level psychosocial factors, yet little is known about how providers understand these inequities for children. This study explored pediatric dialysis and transplant social workers' explanations for racial disparities affecting US black children in kidney transplant access.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with 16 pediatric dialysis and transplant social workers from across the US. Participants were recruited through professional listservs and direct outreach to pediatric nephrology programs. Interview transcripts were analyzed using thematic analysis informed by ecological systems theory.</p><p><strong>Results: </strong>Four primary themes emerged: lack of resources, family composition, distrust, and systemic racism. The barriers to transplant that black children face are not limited to the patient-level microsystem as previously described in the literature but rather persist across all ecological system layers. Social workers identified microsystem level barriers as having mesosystem level impact when provider bias leads to judgment about transplant readiness. Social workers named systemic racism as a barrier that transcends all levels of the ecological system, from microaggressions to provider bias to race \"corrections\" in clinical algorithms to white supremacy to the legacy of slavery.</p><p><strong>Conclusions: </strong>Findings suggest that transplant evaluation processes may reinforce structural racism. Unlike prior studies emphasizing patient-level explanations, participants identified healthcare systems as key contributors to inequity. Further research should seek the voices of black patients and identify interventions to improve equity.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70492"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}