Pediatric Transplantation最新文献

{"title":"Navigating Uncertainty: Characterizing Rebound Lactic Acidosis in Pediatric Normothermic Machine Perfusion.","authors":"Chun-Sing Huang, Alonzo Needum, Sarah G Van Winkle, Gwendolyn B Henry, Rayhan Neil Jhanji, Emma Hills, Naseem Ravanbakhsh, Abbas Rana, Kyle Soltys, George Mazariegos, N Thao N Galván, John Goss","doi":"10.1111/petr.70500","DOIUrl":"10.1111/petr.70500","url":null,"abstract":"<p><strong>Background: </strong>Normothermic machine perfusion (NMP) is an emerging strategy for pediatric liver transplantation, but pediatric-specific viability criteria remain undefined. Lactate clearance, extrapolated from adult protocols, is a central marker of allograft function. In our pediatric NMP (pNMP) experience, we observed a novel pattern: initial clearance followed by secondary rise, termed rebound lactic acidosis.</p><p><strong>Methods: </strong>We retrospectively reviewed pediatric liver allografts preserved on the TransMedics Organ Care System at two centers (January 2025 through June 2026). After excluding donors > 35 kg, 18 perfusions (17 transplants) were classified as rebound lactic acidosis (lactate rise > 0.5 mmol/L after initial clearance) or sustained clearance. Rebound cases were characterized by lactate kinetics, perfusion parameters, acid-base status, bile production, histology, and recipient outcomes.</p><p><strong>Results: </strong>Six allografts demonstrated rebound, with onset 1.0-6.6 h into perfusion. All sustained bile production throughout perfusion. Circuit alkalosis temporally correlated with rebound in three cases and improved with gas flow reduction. The first allograft was discarded; the remaining five were transplanted, including one perfused for 35.5 h. Recipients had elevated POD1 transaminases and INR that normalized by POD7; three are discharged home and two remain hospitalized, all with functioning allografts (follow-up up to 312 days).</p><p><strong>Conclusions: </strong>Rebound lactic acidosis during pNMP may not indicate allograft nonviability and may be ameliorated by modifying circuit perfusion or pH. Lactate kinetics should be interpreted within a multiparametric viability framework incorporating perfusion adequacy, acid-base status, bile production, liver function, and histology. Pediatric-specific criteria are needed to safely expand the donor pool.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70500"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183747","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":"Optimized Cytomegalovirus-DNA Threshold for Preemptive Therapy in Pediatric Liver Transplant Recipients: A Mixed-Effects Model-Based Analysis of Prospective Cohort Data.","authors":"Matteo Pelucchi, Eleonora Severi, Michele Totaro, Francesco Morotti, Ilaria Passera, Andrea Francavilla, Angelo Di Giorgio, Alessandra Tebaldi, Marco Enrico Giovanni Arosio, Cristina Russo, Andrea Pietrobattista, Marco Sciveres, Daniele Di Carlo, Giusy Ranucci, Cristina Costa, Michele Pinon, Michela Bravi, Marc Garcia Lorenzo, Ezio Bonanomi, Domenico Pinelli, Lorenzo D'Antiga, Emanuele Nicastro","doi":"10.1111/petr.70472","DOIUrl":"10.1111/petr.70472","url":null,"abstract":"<p><strong>Background: </strong>Cytomegalovirus (CMV) remains one of the most significant infectious complications after pediatric liver transplantation (LT). Although preemptive therapy (PET) is an effective and widely supported strategy, the choice of a clinically actionable CMV-DNA threshold varies substantially among centers. We aimed to evaluate below-standard CMV-DNA thresholds able to accurately predict clinically significant infection (CSI) while preventing overtreatment in children after LT.</p><p><strong>Methods: </strong>In this prospective observational study, 66 children were followed for 6 months post-LT with scheduled whole-blood CMV-DNA monitoring. CMV-DNA trajectories were evaluated using mixed-effects spline models and compared by clinical outcome and serologic risk. Threshold performance was assessed through interpolated viral-load curves for all infected patients. Sensitivity, overtreatment rate, and positive predictive value (PPV) were estimated for the candidate thresholds.</p><p><strong>Results: </strong>CSI occurred in 19/66 patients (28.7%), while 28 had abortive infections (AI), and 19 showed no infection. CSI displayed significantly higher and more sustained CMV-DNA trajectories compared with AI (p < 0.0001). Serologic risk did not modify viral kinetics. Threshold analysis identified 40 000 IU/mL (57 140 copies/mL) as the optimal PET cut-off: it treated all CSI cases (sensitivity 94.7%, 95% CI 88.9-100), resulted in no overtreatment, and maintained high PPV (100%). Lower thresholds increased overtreatment (up to > 50%), while higher ones added no clinical advantage.</p><p><strong>Conclusions: </strong>A CMV-DNA threshold of 40 000 IU/mL in whole blood optimally balances timely PET initiation with avoidance of unnecessary antiviral therapy. These findings support a standardized, clinically pragmatic approach to PET in pediatric LT.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70472"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183792","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":"Pre-Transplant CT Body Composition and Graft Outcomes in Pediatric Kidney Transplant Recipients: Revisiting the Adult Paradigm.","authors":"Min Li, Xiaohua Li, Zhaoyu Bai, Tingting Luo, Yumei Xu, Mengting Deng, Ruyi Wu, Bingfeng Lu, Liling Long","doi":"10.1111/petr.70459","DOIUrl":"https://doi.org/10.1111/petr.70459","url":null,"abstract":"<p><strong>Background: </strong>Pre-transplant sarcopenia predicts adverse outcomes in adult kidney transplant recipients. Whether this association extends to pediatric populations-who exhibit distinct immunological profiles, growth dynamics, and adherence challenges-remains unknown. We investigated the relationship between computed tomography (CT)-quantified body composition and graft outcomes in children.</p><p><strong>Methods: </strong>Single-center retrospective cohort study of 46 pediatric kidney transplant recipients (age < 18 years) with preoperative T12-level CT imaging (2020-2024). Skeletal muscle area (SMA), intermuscular adipose tissue (IMAT), skeletal muscle density (SMD), and skeletal muscle index (SMI) were measured. The primary outcome was a composite endpoint of graft failure, defined as permanent return to dialysis (hemodialysis or peritoneal dialysis), re-transplantation, or death from any cause. Univariable Cox models were the primary analyses; multivariable models were exploratory given limited events (n = 12).</p><p><strong>Results: </strong>Transplant recipients had significantly lower SMA (61.05 vs. 65.54 cm², p = 0.049), IMAT (0.80 vs. 1.72 cm², p < 0.001), and BMI (17.30 vs. 20.41 kg/m², p < 0.001). Over a median follow-up of 45 months, 12 patients experienced the primary outcome. Univariable Cox regression revealed no statistically significant association between the primary outcome and SMA (HR 0.99, 95% CI 0.96-1.03), IMAT (HR 1.18, 95% CI 0.73-1.90), SMD (HR 1.04, 95% CI 0.94-1.15), or SMI (HR 0.98, 95% CI 0.85-1.13). Multivariable models, conducted as exploratory sensitivity analyses, yielded consistent non-significant results.</p><p><strong>Conclusion: </strong>No statistically significant association was detected between pre-transplant body composition parameters and adverse outcomes in this cohort of pediatric kidney transplant recipients. These preliminary findings suggest caution in directly extrapolating adult sarcopenia thresholds to children and highlight the need for larger, adequately powered pediatric studies to develop age-specific risk stratification tools.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70459"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128234","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":"Donor-Derived Cell-Free DNA-Guided Rejection Surveillance in Medium- and High-Risk Pediatric Heart Transplant Recipients: A Single-Center Experience.","authors":"Stephanie Ghaleb, Nathanya Baez-Hernandez, Tracey Ellimuttil, Laura Radel, Melodie Lynn, Maria Bano, Ryan Butts","doi":"10.1111/petr.70482","DOIUrl":"https://doi.org/10.1111/petr.70482","url":null,"abstract":"<p><strong>Background: </strong>Allograft rejection remains a leading cause of morbidity in pediatric heart transplant (HT) recipients. Endomyocardial biopsy (EMB), the standard for surveillance, is invasive and resource-intensive. Donor-derived cell-free DNA (dd-cfDNA) is a promising noninvasive biomarker, though pediatric data remain limited.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of 50 pediatric HT recipients (< 18 years) at a single quaternary center. Medium- and high-risk patients managed with a dd-cfDNA-guided protocol (n = 25) were compared with a historical biopsy-based cohort (n = 25). Primary outcomes included biopsy frequency and incidence of clinically significant rejection (ACR ≥ 2R, pAMR ≥ 2, or treated rejection) over the first year post-HT.</p><p><strong>Results: </strong>The dd-cfDNA group underwent fewer biopsies (p = 0.005), with only 4% requiring ≥ 5 biopsies versus 16% in controls. There was no difference in 12-month rejection incidence (39% vs. 25%, p = 0.99). Biopsy yield was higher in the dd-cfDNA group (p = 0.053). Among rejection episodes, 88% were preceded by increased dd-cfDNA, with a significant relative rise within 30 days (104%, p = 0.021).</p><p><strong>Conclusion: </strong>In medium- and high-risk pediatric HT recipients, dd-cfDNA-guided surveillance reduced biopsy utilization without increasing rejection. These findings support dd-cfDNA as a clinically useful adjunct to optimize surveillance strategies in pediatric transplantation.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70482"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137992","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":"Understanding the Immune Response Changes to Clinical Interventions for Epstein-Barr Virus Infection Prior to Lymphoma Development in Children After Organ Transplants (UNEARTH).","authors":"Vikas R Dharnidharka, Claire Bocchini, Swati Choudhry, Elizabeth Moulton, Lujain Jaza, Joseph Dumayas, Camila Macedo, Elizabeth Zaragoza, Maryam Mysorewala, Michelle Becker-Hapak, Mark Foster, Mansi Agarwal, Charles W Goss, Kenneth B Schechtman, Kate Nolt, Juan Diego Ramirez, Eileen Rios-Abdallah, Raja Dandamudi, Michael Green, Kristine M Wylie, Todd A Fehniger, Diana Metes, Lara Danziger-Isakov","doi":"10.1111/petr.70487","DOIUrl":"10.1111/petr.70487","url":null,"abstract":"<p><strong>Background: </strong>Post-transplant lymphoproliferative disorders (PTLD) remain a major complication of solid organ transplants (SOT), occurring in 1%-10% of patients, but in greater proportions in children. About 50%-80% of cases are Epstein-Barr Virus (EBV) associated, through partially known and still unknown mechanisms. Even in EBV seronaive SOT recipients, transplant of an SOT from an EBV seropositive donor does not always lead to peripheral blood EBV replication. Longitudinal peripheral blood EBV DNA nucleic acid testing (NAT) after SOT has not improved the individual prediction of PTLD occurrence, likely due to variable SOT recipient immune responses.</p><p><strong>Methods: </strong>This prospective study is designed to assess longitudinal and comprehensive T and NK cell phenotyping and responses to peripheral blood EBV replication via multispectral flow cytometry and other assays. We will also compare local to central EBV NAT values and test whether torquetenovirus NAT can act as a simpler assay to predict EBV clearance. We will collect 1390 blood samples across 5 time points in the first year after 347 enrolled (278 completed) SOTs (kidney, liver, heart, lung or intestine) from three major pediatric SOT centers in the U.S.A.</p><p><strong>Results: </strong>As of June 30, 2025, our study has enrolled 133 participants, of whom 110 have received an organ transplant (27% Hispanic ethnicity, 16% black race, median age 8 years, across all 4 major SOT types).</p><p><strong>Conclusions: </strong>By study end, we will know the global immune responses to EBV replication across a spectrum of clinical pediatric SOT situations. We expect to find key immune mechanisms that will predict poor or delayed EBV clearance despite clinical interventions. These findings may lead to new translational immunotherapy approaches to treat EBV DNaemia or prevent PTLD. We expect that our findings will also inform EBV oncogenesis in other immunocompromised or immunocompetent populations.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70487"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149607","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":"Impact of Operative Time on Pediatric Heart Transplant Outcomes: An Analysis of the United Network for Organ Sharing Registry.","authors":"Akosua Dansoa Odei, Haoran Jiang, Natasha Anders, Seth Erasmus Murray Wolf, Chelsea Harris, Rebekah Boyd, Matthew Galen Hartwig, Douglas Marvin Overbey, Joseph William Turek","doi":"10.1111/petr.70474","DOIUrl":"https://doi.org/10.1111/petr.70474","url":null,"abstract":"<p><strong>Background: </strong>Heart transplantation is definitive therapy for children with end-stage heart failure. Because donor availability is unpredictable, transplantation occurs overnight or on weekends. Although studies report mixed findings on the association between operative timing and outcomes, pediatric data remain limited. We evaluated the impact of operative timing on pediatric heart transplant outcomes.</p><p><strong>Methods: </strong>We studied pediatric heart transplant recipients (< 18 years) in the United Network for Organ Sharing registry from 2000 to 2018. Transplants were classified by time of day (day: 9 AM-8:59 PM; night: 9 PM-8:59 AM) and day of week (weekday vs. weekend). Primary outcome was survival. Secondary outcomes included graft survival, rejection, retransplantation, and postoperative complications. Survival was analyzed using Kaplan-Meier and log-rank testing. Multivariable Cox regression adjusted for recipient and donor characteristics and pre-transplant support.</p><p><strong>Results: </strong>Among 6125 recipients, 2930 (47.8%) transplants occurred during the day and 3195 (52.2%) at night; 4408 (72.0%) occurred on weekdays and 1717 (28.0%) on weekends. Kaplan-Meier analysis demonstrated no significant survival difference between daytime and nighttime transplants (p = 0.266) or weekday and weekend transplants (p = 0.210). In multivariable Cox regression, operative timing was not associated with mortality (night vs. day: hazard ratio 0.97, 95% confidence interval 0.89-1.06, p = 0.554; weekend versus weekday: hazard ratio 1.04, 95% confidence interval 0.94-1.15, p = 0.445). Acute rejection prior to discharge and treatment for rejection within 1 year was more frequent in daytime transplants without affecting graft survival.</p><p><strong>Conclusions: </strong>Operative timing was not associated with patient survival, graft survival, or postoperative outcomes after pediatric heart transplantation.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70474"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075697","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":"Improving Access to Transplant: A Quality Improvement Initiative to Reduce Time From Outpatient Dialysis Initiation to Deceased Donor Kidney Transplant Activation.","authors":"Priyanka Chati, Jessica Whittington, Karissa Braden, Verghese Priya S, Kaitlyn White, Katrina Andracki, Cara McGarry, Stella Kilduff, Ricardo Superina, Mahima Keswani","doi":"10.1111/petr.70473","DOIUrl":"https://doi.org/10.1111/petr.70473","url":null,"abstract":"<p><strong>Background: </strong>Pre-emptive kidney transplantation is the preferred treatment in patients with end-stage kidney disease (ESKD); however, many patients must unavoidably initiate dialysis prior to transplantation. Prolonged dialysis exposure is associated with increased morbidity and mortality, mandating prompt transition to transplant when possible. Delays in transplant readiness are unfortunately prevalent and are often driven by fragmented communication, limited education, and system-level barriers.</p><p><strong>Objective: </strong>To reduce time from dialysis initiation to deceased donor kidney transplant (DDKT) activation among pediatric patients through a single-center quality improvement initiative.</p><p><strong>Methods: </strong>This quality improvement (QI) project was conducted at a tertiary children's hospital affiliated with a pediatric outpatient dialysis unit. Baseline data from 2023 demonstrated a median dialysis-to-DDKT activation time of 211.5 days. Interventions were implemented in 2024 through three Plan-Do-Study-Act cycles (PDSA): (1) establishment of a multidisciplinary Guidance and Planning clinic for early transplant education; (2) implementation of biweekly transplant-dialysis coordination meetings supported by expanded transplant coordinator staffing; (3) distribution of a bilingual patient education booklet at dialysis initiation. The primary outcome measure was time to DDKT activation. Trends were evaluated using descriptive statistics and a run chart.</p><p><strong>Results: </strong>In 2024, 10 patients initiated dialysis during the intervention phase. Excluding 2 patients who were activated for transplantation prior to outpatient dialysis initiation, the median time from dialysis initiation to DDKT activation decreased by 38%, from 211.5 days in 2023 to 130.5 days in 2024. Sixty percent of patients initiating dialysis in 2024 underwent transplantation within the same calendar year. Process measures demonstrated successful implementation of interventions.</p><p><strong>Conclusions: </strong>Implementation of a structured quality improvement approach was associated with reduced time to transplant activation in pediatric dialysis patients. Improved communication, education, and transplant coordination may represent modifiable factors that may enhance transplant readiness and outcomes.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70473"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113744","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":"Pediatric Guillain-Barré Syndrome Post Organ Transplant: Acute and Chronic Complication Requiring High Index of Suspicion.","authors":"Liora Rabizadeh, Paola Pergami","doi":"10.1111/petr.70481","DOIUrl":"10.1111/petr.70481","url":null,"abstract":"<p><strong>Background: </strong>Guillain-Barré syndrome (GBS) is an acute, immune-mediated polyradiculoneuropathy most often triggered by infections such as Campylobacter jejuni, Epstein-Barr virus (EBV), or cytomegalovirus (CMV). Although transplant-associated GBS is recognized in adults, it remains rare in pediatric recipients, and distinguishing immune-mediated disease from medication toxicity or critical illness can be challenging.</p><p><strong>Methods: </strong>We describe two pediatric cases of GBS following organ transplantation, one after liver transplant and one after small bowel transplant. Clinical features, diagnostic evaluation, immunosuppression exposure, electrodiagnostic findings, imaging, and treatment outcomes were reviewed to characterize presentation patterns and diagnostic challenges.</p><p><strong>Results: </strong>The first patient developed rapidly progressive weakness shortly after liver transplantation in the setting of organ failure, adenovirus infection, and transient supratherapeutic tacrolimus levels. She demonstrated severe motor axonal involvement on nerve conduction studies and elevated neurofilament light chains, improving after intravenous immunoglobulin (IVIG). The second patient, years after small bowel transplantation complicated by chronic immune dysregulation and EBV viremia, presented with ascending weakness, areflexia, elevated CSF protein, and MRI enhancement of cauda equina and cranial nerves. Electrodiagnostics confirmed demyelinating polyneuropathy. Symptoms improved after IVIG despite concurrent tacrolimus level elevation. Across both cases, infectious triggers, immunosuppression, and critical illness obscured early recognition.</p><p><strong>Conclusion: </strong>GBS is an uncommon but important cause of acute weakness in pediatric transplant recipients. These cases show that GBS can occur both early and late after transplantation and may mimic medication toxicity or other complications. Early consideration of GBS, timely electrodiagnostic testing, and prompt immunotherapy are essential for optimizing outcomes in these patients.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70481"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112195","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":"Astrovirus Gastroenteritis Mimicking Necrotizing Enterocolitis in a Pediatric Liver Transplant Recipient: A Case Report and Successful Conservative Management.","authors":"Kübra Arslan, Arzu Meltem Demir, İlkin Elif Günel Karaburun, Ceyda Tuna Kırsaçlıoğlu, Ömer Suat Fitoz, Meltem Bingöl Koloğlu, Aydan Kansu, Zarife Kuloğlu","doi":"10.1111/petr.70496","DOIUrl":"10.1111/petr.70496","url":null,"abstract":"<p><strong>Introduction: </strong>Necrotizing enterocolitis (NEC) is predominantly a disease of premature infants and is rarely in older children. In immunocompromised patients, however, infectious enteritis may present with clinical and radiological findings resembling NEC. In this article, we present a pediatric liver transplant recipient who developed astrovirus-induced gastroenteritis, pneumatous intestinalis, and portal venous gas and was successfully treated without surgery.</p><p><strong>Case report: </strong>A 24-month-old girl presented with hematochezia 4 months after liver transplantation for hepatoblastoma while receiving tacrolimus, mycophenolate mofetil, and corticosteroid therapy. She had a recent history of diarrhea followed by abdominal distention and lower gastrointestinal bleeding. Imaging studies demonstrated pneumatosis intestinalis and portal venous gas. Blood and stool cultures, Clostridium difficile antigen testing, and respiratory pathogen panels were negative, whereas stool PCR identified astrovirus. Based on the clinical presentation and imaging findings, Bell stage II NEC was diagnosed. The patient was managed conservatively with bowel rest, total parenteral nutrition, broad-spectrum antimicrobial therapy, and temporary adjustment of immunosuppressive treatment. Her bleeding resolved within 48 h, serial imaging showed regression of pneumatosis intestinalis, and she was discharged after 14 days with complete clinical recovery.</p><p><strong>Conclusion: </strong>Astrovirus infection should be considered among the potential causes of NEC-like gastrointestinal manifestations in pediatric liver transplant recipients. Although pneumatosis intestinalis and portal venous gas often due to intestinal ischemia, clinically stable transplant recipients may recover with careful monitoring and individualized conservative treatment, avoiding unnecessary surgical intervention.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70496"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196099","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":"Comment on \"Transmission of Anellovirus From Kidney-Donor to Pediatric Recipient\".","authors":"Muhammad Ahmad Khan, Nida Sher","doi":"10.1111/petr.70483","DOIUrl":"https://doi.org/10.1111/petr.70483","url":null,"abstract":"","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70483"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113763","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}