Pediatric Transplantation最新文献

{"title":"Early Hematopoietic Stem Cell Transplantation in Type 1 Fucosidosis: Reversal of Central Tegmental Tract Abnormalities.","authors":"Mehmet Palaz, Ahmet Taşkın, Esra Özpınar, Yasemin Topçu, Yöntem Yaman, Betül Kılıç, Kürşad Aydın","doi":"10.1111/petr.70502","DOIUrl":"https://doi.org/10.1111/petr.70502","url":null,"abstract":"<p><strong>Background: </strong>Fucosidosis is an ultra-rare lysosomal storage disorder caused by alpha-L-fucosidase deficiency, leading to progressive neurodegeneration and multisystem involvement. Hematopoietic stem cell transplantation (HSCT) has emerged as a potential disease-modifying therapy, particularly when performed early in the disease course. However, neuroradiological reversibility after HSCT remains insufficiently documented.</p><p><strong>Methods: </strong>We report a male infant diagnosed with Type 1 fucosidosis at 6 months of age based on enzymatic and genetic analyses. Brain magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) demonstrated characteristic abnormalities, including central tegmental tract involvement. The patient underwent allogeneic HSCT at 14 months of age and was followed clinically and radiologically.</p><p><strong>Results: </strong>Following HSCT, the patient demonstrated stabilization and gradual improvement of neurological functions. Follow-up neuroimaging revealed marked regression of white matter abnormalities and reversal of central tegmental tract hyperintensities. Developmental progression improved after transplantation, and no major transplant-related neurological complications occurred.</p><p><strong>Conclusion: </strong>Early HSCT was accompanied by clinical improvement and resolution of central tegmental tract abnormalities in this patient. These imaging changes may help assess treatment response, though larger cohorts and longer follow-up are needed to evaluate long-term outcomes.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70502"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207538","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 Liver Transplantation in the Treatment of Solid Liver Tumors: A Narrative Review.","authors":"Simone Zaragoza, Haaris Kadri, Tobias S Broering, Alfred Joseph Tector, Richard Mangus, Phillipe Abreu","doi":"10.1111/petr.70494","DOIUrl":"https://doi.org/10.1111/petr.70494","url":null,"abstract":"<p><p>Pediatric primary liver malignancies comprise a heterogeneous group of tumors requiring individualized multidisciplinary management. Hepatoblastoma and hepatocellular carcinoma remain the most common malignant liver tumors in children, whereas rare hepatic neoplasms account for a small but clinically significant proportion of cases. Over the past two decades, advances in tumor biology, standardized radiologic staging, multidisciplinary treatment planning, and liver transplantation have substantially improved outcomes, particularly for children with unresectable hepatoblastoma. Contemporary management has shifted from an anatomy-based approach to individualized treatment strategies that integrate molecular characterization, PRETEXT staging, response to neoadjuvant therapy, and careful assessment of surgical resectability. Liver transplantation is now recognized as a definitive oncologic treatment for carefully selected children with unresectable hepatoblastoma, selected cases of hepatocellular carcinoma, and, in exceptional circumstances, other rare hepatic malignancies. In parallel, improvements in post-transplant oncologic surveillance and immunosuppressive management have expanded opportunities for long-term disease control while emphasizing the need to balance graft preservation with recurrence risk. Emerging technologies, including molecular biomarkers, liquid biopsy, artificial intelligence, and advanced surgical planning, together with international collaborative initiatives, are expected to further refine patient selection and post-transplant management. This review summarizes current evidence on the role of liver transplantation in pediatric liver malignancies and discusses contemporary advances reshaping pediatric transplant oncology.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70494"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183797","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":"Intraoperative Anesthetic Parameters Predict Early Allograft Dysfunction in Pediatric Living Donor Liver Transplantation.","authors":"Taylan Sahın, Ali Sait Kavaklı, Alaaddin Aydın, Cansu Altuntas, Mey Talıp, Nese Kutluturk Sahın, Mehmet Tokac, Eryigit Eren, Kazım Kutluturk, Ayhan Dınckan","doi":"10.1111/petr.70453","DOIUrl":"https://doi.org/10.1111/petr.70453","url":null,"abstract":"<p><strong>Background: </strong>Early allograft dysfunction (EAD) is a major complication of pediatric liver transplantation associated with prolonged ICU stay, increased mortality, and graft loss. Existing risk models focus on donor and surgical variables; the contribution of intraoperative anesthetic management remains poorly characterized in pediatric living donor liver transplantation (LDLT).</p><p><strong>Methods: </strong>We conducted a retrospective single-center cohort study of 124 consecutive pediatric LDLT recipients. Three intraoperative anesthetic parameters were evaluated as predictors of EAD (Olthoff criteria): relative mean arterial pressure (MAP) drop (%), norepinephrine (NE) infusion duration (min), and peak intraoperative lactate (mmol/L). Discriminative performance was assessed by receiver operating characteristic (ROC) analysis. Multivariable Firth penalized logistic regression addressed near-complete separation. Internal validation used bootstrap resampling (1000 iterations).</p><p><strong>Results: </strong>The cohort (median age 18.5 months, IQR 8.0-96.0; biliary atresia the most common indication) included 50 patients (40.3%) with EAD. All three parameters showed excellent univariable discrimination: NE duration (AUC = 0.993), peak lactate (AUC = 0.936), and MAP drop (AUC = 0.894); all p < 0.001. Three preoperative variables (hemoglobin, bilirubin, albumin) reached univariable significance (all p < 0.05) but with modest discrimination (AUC 0.384-0.617), markedly inferior to all intraoperative parameters (AUC 0.894-0.996). In the multivariable model, MAP drop (OR 22.27; 95% CI 1.80-275.4; p = 0.016) and NE duration (OR 3066657; p = 0.018) independently predicted EAD. The combined model achieved AUC = 0.999 (bootstrap 95% CI: 0.994-1.000; Brier score = 0.013). NE duration ≥ 70 min yielded sensitivity 1.000 and NPV 1.000. EAD-positive patients had significantly longer ICU stay (5 vs. 3 days; p = 0.004) and mechanical ventilation duration (24 vs. 0 h; p < 0.001).</p><p><strong>Conclusions: </strong>Intraoperative anesthetic parameters-particularly NE duration and MAP drop-are powerful independent predictors of EAD in pediatric LDLT, substantially outperforming preoperative variables, three of which reached statistical significance but with markedly lower discriminative power. Intraoperative hemodynamic management may represent a modifiable determinant of early graft outcomes. External validation is warranted.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70453"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170224","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":"First Split Liver Transplantation Using VitaSmart Hypothermic Machine Perfusion in the United States.","authors":"Anastasia M Kahan, Francisca van der Schyff, Todd Robinson, Ivan Rodriguez, Tavis Shaw, Enoch Zenger, M Kyle Jensen, Jean F Botha, Zachary J Kastenberg","doi":"10.1111/petr.70504","DOIUrl":"10.1111/petr.70504","url":null,"abstract":"<p><strong>Background: </strong>Dynamic perfusion techniques are increasingly used in liver transplantation to improve graft preservation and support preimplantation assessment. Its reported use in split liver transplantation remains limited. We report the first use of the VitaSmart hypothermic perfusion device for graft preservation during ex situ split in the United States, resulting in the successful transplantation of a right trisection graft into an adult recipient and a left lateral section graft into a pediatric recipient.</p><p><strong>Methods: </strong>A deceased donor liver was split into a right trisection graft for an adult recipient and a left lateral segment graft for a pediatric recipient. Both grafts underwent VitaSmart hypothermic oxygenated perfusion. Donor, graft, perfusion, operative, and early postoperative outcomes were reviewed. The adult recipient was a 63-year-old man with metabolic dysfunction-associated steatohepatitis cirrhosis. The pediatric recipient was a 4-year-old female with Joubert syndrome, congenital hepatic fibrosis with portal hypertension, and prior renal transplantation.</p><p><strong>Results: </strong>The right trisection graft weighed 1001 g, with an estimated graft-to-recipient weight ratio of 1.1. Implantation was performed with bicaval, portal vein, hepatic artery, and duct-to-duct biliary anastomoses. Reperfusion was uneventful, with uniform graft perfusion, normal intraoperative vascular waveforms, and bile production. The left lateral segment graft was implanted using piggyback caval implantation and Roux-en-Y biliary reconstruction. Postoperative Doppler demonstrated patent vessels. Early findings in both recipients demonstrated vascular patency and graft recovery.</p><p><strong>Conclusions: </strong>This initial experience demonstrates the technical feasibility of incorporating VitaSmart hypothermic machine perfusion into split liver transplantation and highlights its potential role in expanding split graft utilization.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70504"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183799","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":"Post-Operative Acute Kidney Injury After Pediatric Heart Transplantation and Longitudinal Invasive Assessment of Cardiac Filling Pressures.","authors":"Faizeen Zafar, Katja M Gist, Alejandro A Floh, Nicholas J Ollberding, Dana Fuhrman, Danielle E Soranno","doi":"10.1111/petr.70503","DOIUrl":"https://doi.org/10.1111/petr.70503","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) has been associated with diastolic dysfunction in pre-clinical studies, but with limited evaluation in clinical settings. We sought to examine the association between post-operative AKI and diastolic function after pediatric heart transplantation.</p><p><strong>Methods: </strong>We conducted a single-center retrospective review of patients ≤ 21years undergoing first-time heart transplantation between May 2010-July 2023. AKI was defined and staged per the KDIGO creatinine criteria, with Stage 2 or 3 classified as severe. Right ventricular end-diastolic pressure (RVEDP) and pulmonary capillary wedge pressure (PCWP) obtained from surveillance cardiac catheterizations in the first two years post-transplant were used to assess diastolic function. Linear mixed-effects models were used to compare hemodynamics between groups.</p><p><strong>Results: </strong>We included 101 patients, aged 0-20 years, median 4 years (IQR 0-13). Pre-transplant diagnosis was congenital heart disease (CHD) in 51 (50%) and cardiomyopathy in 50 (50%) patients. Post-operative AKI occurred in 29 (29%) patients; 16/29 had severe AKI. AKI was more common in patients with CHD than cardiomyopathy [20/29 (69%) vs. 9/29 (31%), p = 0.02]. On mixed-effects model analysis adjusting for pre-transplant diagnosis, ischemia time > 4 h, and time since transplantation, severe AKI was associated with higher filling pressures over the first 2 years post-transplant, including a 2.2 mmHg increase in RVEDP (95% CI 1.3-3.1; p < 0.0001) and a 1.8 mmHg increase in PCWP (95% CI 0.8-2.8; p = 0.0005).</p><p><strong>Conclusions: </strong>Severe post-transplant AKI was independently associated with higher biventricular filling pressures, suggesting a clinically relevant kidney-heart interaction. Larger studies are needed to further define its mechanistic and clinical implications.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 10","pages":"e70503"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207585","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 Association of DQ Donor-Recipient Mismatching on Development of Antibody-Mediated Rejection and Donor-Specific Antibody-Positive Rejection After Pediatric Heart Transplantation.","authors":"Lydia K Wright, Erin Albers, Ryan Cantor, Chesney Castleberry, Maryanne Chrisant, Jameson Dyal, James Kirklin, Devin Koehl, Paolo Rusconi, Zdenka Reinhardt, William J Dryer","doi":"10.1111/petr.70451","DOIUrl":"10.1111/petr.70451","url":null,"abstract":"<p><strong>Purpose: </strong>Several studies have shown lower risk of de novo donor specific antibodies (dnDSA) and antibody-mediated rejection (AMR) in adult transplant recipients with less HLA donor-recipient mismatching, particularly at the Class II DQ locus. We aimed to evaluate the association between degree of DQ antigen mismatch and risk for AMR and DSA-positive rejection development in pediatric heart transplant (HT) recipients.</p><p><strong>Methods: </strong>Children who underwent HT from 2012 to 2023 were identified from the Pediatric Heart Transplant Society registry. Those with available DQB1 donor and recipient data obtained from merge with OPTN were included. Number of DQB1 donor-recipient mismatches (DQB1-MM) (and DQA1 for the limited subset) were determined by comparing donor and recipient HLA data. Primary outcomes evaluated were freedom from biopsy-proven AMR and freedom from DSA-positive rejection. Subset analyses were performed for those with available DQA1 data.</p><p><strong>Results: </strong>A total of 3672 HT recipients were included; 1302 (35%) had 2 DQB1-MM, 1945 (53%) had 1 DQB1-MM, and 425 (12%) had 0 DQB1-MM. Those with 0 DQB1-MM were more likely to be White than those with 1 or 2 DQB1-MM (67% vs. 63% and 61%, respectively, p = 0.0268). There were no other significant differences in clinical, demographic, or transplant characteristics between the groups. There was no difference in freedom from biopsy-proven AMR based on number of DQB1-MM in either univariable or multivariable analysis. Freedom from DSA-positive rejection was significantly higher in those with 0 DQB1-MM compared to those with 1 or 2 MM (estimated 92% at 5 years posttransplant compared to 81%, p < 0.001). This association remained significant when controlling for other known rejection risk factors in multivariable analysis.</p><p><strong>Conclusions: </strong>Fewer DQ antigen mismatches are associated with improved freedom from DSA-positive rejection, but not biopsy-proven AMR in children undergoing first HT. Further study is needed to understand long-term implications of this finding and its potential use in improving posttransplant outcomes.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70451"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956185","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":"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":"Role of Respiratory Viral Infections in Airflow Obstruction After Hematopoietic Cell Transplantation.","authors":"Sapna A Pardasani, Ali Y Suliman, Jose A Ferrolino, Ronald H Dallas, Megan Peterson, Pamela Merritt, Amanda Cole, Amber Davis, Ashleigh Gowen, Kim J Allison, Randall T Hayden, Ying Li, Dinesh Keerthi, Saumini Srinivasan, Gabriela M Maron, Brandon M Trilplett, Diego R Hijano","doi":"10.1111/petr.70467","DOIUrl":"10.1111/petr.70467","url":null,"abstract":"<p><strong>Background: </strong>Respiratory viral infections (RVIs) in allogeneic hematopoietic cell transplant (allo-HCT) recipients can cause airflow obstruction (AFO). Despite this risk, the impact of community-acquired RVI on PFTs in pediatric patients after allo-HCT remains unclear.</p><p><strong>Objective: </strong>The study determines the role of RVI in the development of AFO post-transplant among survivors of allo-HCT.</p><p><strong>Study design: </strong>This retrospective study analyzed St. Jude patients undergoing allo-HCT between 2003-2020. AFO was defined by z-scores and forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio expressed as lower limit of normal (LLN). Baseline parameters were obtained before allo-HCT, and Year 1 parameters within 425 days post allo-HCT. Spirometry measures were calculated using the global lung function Initiative (GLI) calculator. Bivariate and multivariate logistic regression identified risk factors for AFO following allo-HCT.</p><p><strong>Results: </strong>A total of 397 patients were included, with a median age of 12.7 years. RVI occurred in 13% of patients within the first 100 days after transplantation. AFO developed in 12% of patients. Among those with AFO, 68% had a baseline FEV1/FVC ratio above the LLN, and 11% had a history of lower respiratory tract infection (LRTI) (p < 0.05). The median time from transplant to RVI was shorter in patients with AFO (12 vs. 34 days). A baseline LLN value was a significant predictor of AFO. However, after adjusting for known covariates, RVI was not independently associated with AFO risk.</p><p><strong>Conclusion: </strong>RVIs within 100 days of allo-HCT did not significantly affect AFO following transplant in pediatric patients.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70467"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149063378","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":"Pediatric Repeat Lung Transplantation: A Contemporary Analysis of Trends and Outcomes.","authors":"Wonshill Koh, JangDong Seo, Todd Jenkins, Don Hayes","doi":"10.1111/petr.70460","DOIUrl":"10.1111/petr.70460","url":null,"abstract":"<p><strong>Background: </strong>Repeat lung transplant (re-LTx) is the only life-saving treatment option for those with irreversible allograft failure. Using a multi-institutional registry database, we investigated the prevalence and outcomes of pediatric re-LTx over the past 35 years.</p><p><strong>Methods: </strong>A retrospective analysis was performed using the Scientific Registry of Transplant Recipients (SRTR). First-time and repeat pediatric LTx candidates from 1989 to 2024 were identified. Univariate analyses, multivariable Cox regression, and Kaplan-Meier plots were performed for a comprehensive analysis.</p><p><strong>Results: </strong>We identified 1396 primary LTx and 81 re-LTx recipients. The transplant-free survival rates for the primary and re-LTx groups were 80% versus 65% at 1-year (p = 0.004). Re-LTx was a risk factor for worse 1-year post-LTx outcomes (HR 1.82; 95% CI 1.19, 2.8; p = 0.006). The days between primary and re-LTx (< 1 year vs. > 1 year) did not have a statistically significant impact on 1-year post-re-LTx outcomes (HR 0.78; 95% CI 0.28, 2.13; p = 0.63). Those requiring mechanical ventilation (MV) at the time of re-LTx had worse outcomes (HR 2.26; 95% CI 1.14, 4.45; p = 0.02). Unlike children following primary LTx, there was no significant improvement in outcomes over time in children with re-LTx (HR 1.04; 95% CI 0.41, 2.61; p = 0.94 for transplant era 2013-2024 vs. 1989-2000).</p><p><strong>Conclusions: </strong>Clinical outcomes for pediatric re-LTx over the past 35 years in the United States remain significantly inferior compared to those for primary LTx. Given these findings, pediatric re-LTx should carefully be considered and restricted to judiciously selected candidates, ideally prior to the development of MV requirement.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70460"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990822","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":"Outcomes of ABO-Incompatible Versus ABO-Compatible Liver Transplantation in Pediatric Recipients: An Updated Systematic Review and Meta-Analysis.","authors":"Kalpana Panda, Bikrant Bihari Lal, Rajeev Khanna, Vikrant Sood, Seema Alam","doi":"10.1111/petr.70430","DOIUrl":"10.1111/petr.70430","url":null,"abstract":"<p><strong>Background and objective: </strong>ABO-incompatible (ABO-i) liver transplantation (LT) in children is increasingly used to address organ scarcity, but concerns about immunological, vascular, and biliary complications remain. With evolving desensitization strategies and emerging pediatric data, an updated meta-analysis comparing ABO-i and ABO-compatible (ABO-c) LT is warranted.</p><p><strong>Methods: </strong>PubMed, Embase, and Scopus were searched from inception to June 2026 to include studies evaluating ABO-i versus ABO-c LT in recipients ≤ 18 years of age. Primary outcomes were comparison of 1-, 3-, and 5-year patient and graft survival between the two groups. Secondary outcomes included comparisons of vascular and biliary complications, rejection, cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections, and post-transplant lymphoproliferative disease (PTLD).</p><p><strong>Results: </strong>Seventeen studies were included. Patient survival was comparable between the two groups at 1 year (risk ratio [RR]: 0.97, 95% confidence interval [CI]: 0.94-1.0, p = 0.07), 3 years (RR: 0.98, 95% CI: 0.94-1.01, p = 0.22) and 5 years (RR: 0.97, 95% CI: 0.88-1.07, p = 0.50). Likewise, graft survival showed no significant differences. Incidence of vascular and biliary complications, acute rejection, CMV and EBV infection, and PTLD also did not differ significantly between groups. Antibody-mediated rejection (AMR) was significantly higher in ABO-i recipients (RR: 20.04, 95% CI: 3.25-123.56, p = 0.001), although this finding was based on only four studies. Overall, heterogeneity was low. Certainty of evidence was rated as very low, primarily due to the observational design of included studies and risk of bias.</p><p><strong>Conclusions: </strong>ABO-i LT in pediatric recipients demonstrates survival and complication outcomes comparable to those of ABO-c LT. However, very low certainty of evidence highlights the need for future well-designed prospective studies.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70430"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148831181","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}