Pediatric Transplantation最新文献

{"title":"From Stable Values to Diagnostic Thresholds: Interpreting Donor-Derived Cell-Free DNA in Pediatric Kidney Transplantation.","authors":"Ercan Yılmaz","doi":"10.1111/petr.70463","DOIUrl":"10.1111/petr.70463","url":null,"abstract":"","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70463"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982740","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":"Intraoperative Continuous Kidney Replacement Therapy With Regional Epoprostenol Anticoagulation During Liver Transplantation in a Child With Severe Gastrointestinal Bleeding.","authors":"Eda Eyduran, Duygu İyi, Ayşen Durak Aslan, Ulkar Huseyinova, Merve Havan, Tanıl Kendirli","doi":"10.1111/petr.70469","DOIUrl":"https://doi.org/10.1111/petr.70469","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a significant complication in pediatric liver transplant (LT) patients. This is often exacerbated by liver dysfunction, fluid overload, and metabolic disturbances. Intraoperative continuous kidney replacement therapy (IO-CKRT) is an emerging strategy to manage these complex patients, aiming to stabilize fluid, electrolyte, and acid-base imbalances. Epoprostenol is utilized as an anticoagulant during CKRT to maintain circuit patency, particularly in patients at high risk of bleeding by inhibiting platelet aggregation. However, the use of IO-CKRT with epoprostenol specifically in pediatric LT recipients is poorly documented.</p><p><strong>Methods: </strong>We present a case of a 12 year-old girl with biliary atresia and cirrhosis who underwent urgent LT from a deceased donor. She developed hemorrhagic shock and multi-organ failure, necessitating pre-transplant plasmapheresis and subsequent CKRT with epoprostenol. IO-CKRT was maintained during the 12 h LT to manage acid-base balance, electrolyte levels, and volume status.</p><p><strong>Results: </strong>Despite epoprostenol anticoagulation for hemofiltration, no abnormal bleeding occurred in the gastrointestinal or surgical areas during transplantation. Post-transplantation, the patient's inotropic support requirements decreased within 24 h.</p><p><strong>Conclusions: </strong>IO-CKRT effectively achieves fluid and metabolic balance during LT in pediatric patients with AKI, fluid overload, and metabolic issues. Epoprostenol proves to be a safe and effective regional anticoagulation option for CKRT in bleeding patients undergoing LT, preventing site bleeding without systemic complications. This case highlights a unique and important application that warrants further investigation into its broader effectiveness and potential complications in this vulnerable patient population.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70469"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017678","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":"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":"The IPTA Nashville Consensus Conference on Post-Transplant Lymphoproliferative Disorders After Solid Organ Transplantation in Children: Updates on Classification and Prevention-2026.","authors":"Michael Green, Marian G Michaels, Thomas Gross, Upton Allen, Catherine M Bollard, Olivia Martinez, Masaki Yamada, Steven H Swerdlow","doi":"10.1111/petr.70445","DOIUrl":"10.1111/petr.70445","url":null,"abstract":"<p><p>The 2019 International Pediatric Transplant Association (IPTA) consensus conference assessed available evidence and developed recommendations for various aspects of care relating to post-transplant lymphoproliferative disorders (PTLD) after solid organ transplantation in children. Because of the key role Epstein-Barr Virus (EBV) plays in the pathogenesis of many PTLD cases, it was addressed in many recommendations from the Consensus Conference. Working groups addressed and published three separate manuscripts providing recommendations and identifying key knowledge gaps relating to the diagnosis, prevention, and management of PTLD and EBV infection in this setting. The definition and classification of PTLD were actively discussed, but recommendations were not addressed in these publications. In 2025, a working group of experts in EBV and PTLD initiated an effort to review, describe, and consider the impact of newer data published since the consensus conference on the appropriateness of recommendations made and the status of knowledge gaps identified through the 2019 consensus conference's efforts. This manuscript addresses the results of this work relating to the classification and prevention of PTLD and EBV in pediatric SOT. Trial Registration: ClinicalTrials.gov identifier: NCT05164094; ID NCT06741072.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70445"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920622","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":"The Palliation of Pediatric Kidney Transplantation.","authors":"Taylor R House, Carrie Thiessen","doi":"10.1111/petr.70462","DOIUrl":"10.1111/petr.70462","url":null,"abstract":"<p><p>To ease without curing-this is the essence of palliation. It is also, fundamentally, the objective of organ transplantation. A new kidney is not a cure but a bridge-a way to ease the symptoms of kidney disease and extend life. By definition, kidney transplantation is a form of palliative care. Yet, this alignment has been lost in some aspects of pediatric kidney transplant care. We examine four aspects of transplant care that reveal ongoing disconnection between patients, families, and clinicians across the transplant journey: the transplant lexicon, approaches to adherence, measures of success, and care transition. Applying core palliative care principles, like meaning, agency, connection, and hope, offers a necessary paradigm shift to bridge these clinical divides. To best serve transplant recipients and their families, the field of pediatric transplantation needs to reintegrate palliative care.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70462"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977512","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":"Left Lateral Segment Liver Transplantation in Small Infants: Outcomes From a High-Volume Center.","authors":"Helena Linge, Eva-Doreen Pfister, Vanessa Muth, Sahar Arbabzadah, Jan Forner, Lisa Felgendreff, Nicolas Richter, Markus Quante, Moritz Schmelzle, Ulrich Baumann, Philipp Felgendreff, Cornelius J Van Beekum","doi":"10.1111/petr.70456","DOIUrl":"10.1111/petr.70456","url":null,"abstract":"<p><strong>Background: </strong>Graft selection in small infants is challenging due to size mismatch and the associated risk of vascular or biliary complications.</p><p><strong>Methods: </strong>In this retrospective single-center study, 57 pediatric liver transplants using left lateral segment grafts performed between 2019 and 2024 were analyzed and compared by recipient weight (< 10 kg vs. ≥ 10 kg).</p><p><strong>Results: </strong>Overall graft survival was 88% in the < 10 kg group and 96% in the ≥ 10 kg group. Patient survival at 1, 2, and 4 years was similar between groups (p = 0.500). The graft-to-recipient weight ratio was significantly higher in smaller recipients (4.64% vs. 2.37%, p < 0.05), and hepatic artery thrombosis occurred only in this group (9%). Biliary complications were comparable between cohorts (27% vs. 30%). Acute cellular rejection (57% vs. 12%, p < 0.001) and 90-day readmissions (57% vs. 27%, p = 0.022) were significantly more common in children weighing ≥ 10 kg.</p><p><strong>Conclusion: </strong>In this selected cohort, left lateral segment transplantation was associated with excellent outcomes across weight groups. Acceptable results in small infants were achieved despite higher GRWR in a specialized setting, supporting LLS grafts as an important option to improve access to timely pediatric transplantation.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70456"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912653","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":"Effect of Pediatric Heart Transplant Waitlist Inactivation on Waitlist and Posttransplant Outcomes.","authors":"Dean S Karahalios, Christina Laternser, Philip Thrush, Adam Morrison, Michael Mongé, Defne A Magnetta","doi":"10.1111/petr.70454","DOIUrl":"10.1111/petr.70454","url":null,"abstract":"<p><strong>Background: </strong>Little is known about pediatric heart transplant candidates facing waitlist inactivation. We characterized them and assessed the impact of inactivation on waitlist and transplant outcomes.</p><p><strong>Methods: </strong>The Organ Procurement and Transplantation Network database was queried for pediatric heart-only transplant candidates. Characteristics, waitlist mortality, and 1-year posttransplant survival between inactivated and non-inactivated patients were compared. Predicted probability for the composite outcome of waitlist mortality or removal due to clinical deterioration over time was computed.</p><p><strong>Results: </strong>Of 5202 patients, 1716 (33%) were inactivated, mostly due to temporary illness (58%). Reasons for inactivation varied by age but not diagnosis. Inactivated patients had longer waitlist duration (171 [77-391] vs. 62 [21-144], p < 0.001), more congenital heart disease (61.0% vs. 55.2%, p < 0.001), and were more often supported by ventricular assist device (47.9% vs. 32.9%, p < 0.001) and invasive ventilation at listing (19.9% vs. 13.6%, p < 0.001). Inactivated patients were less likely listed Status 1A (56.8% vs. 62.3%, p < 0.001) and less likely under intensive care at transplant (43.9% vs. 50.2%, p < 0.001). Inactivated patients had higher 1-year waitlist mortality and removal due to clinical deterioration (SHR 4.40 [3.72-5.20], p < 0.001), though this risk decreased with longer inactive time. One-year posttransplant survival was similar between groups.</p><p><strong>Conclusions: </strong>Waitlist inactivation was strongly associated with 1-year waitlist mortality and removal due to clinical deterioration. However, this risk decreased with longer inactive time and made no difference in short-term posttransplant survival. Thus, the prognostic implications of inactivation are dynamic and can inform future donor allocation policy development.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70454"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148970730","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 \"Terlipressin Therapy for Portal Hyperperfusion Secondary to Portal Vein Size Discrepancy After Pediatric Liver Transplant\".","authors":"","doi":"10.1111/petr.70399","DOIUrl":"10.1111/petr.70399","url":null,"abstract":"","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70399"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977443","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":"Hospitalization Costs of Kidney Transplantation Associated With Induction Therapy Among Pediatric Kidney Transplant Recipients: A North American Pediatric Renal Trials and Collaborative Studies and Pediatric Health Information System Collaborative Study.","authors":"Nancy M Rodig, Daniella Levy Erez, Helen P Pizzo, Troy Richardson, Michael J Somers","doi":"10.1111/petr.70441","DOIUrl":"10.1111/petr.70441","url":null,"abstract":"<p><strong>Background: </strong>Choice of induction agent at the time of pediatric kidney transplantation is primarily influenced by recipient characteristics and center practice. The economic implications of this choice have not been reported in a pediatric cohort.</p><p><strong>Methods: </strong>This is a retrospective study of merged data from North American Pediatric Renal Trials and Collaborative Studies transplant registry with data in the Pediatric Health Information Systems. We estimated costs of the kidney transplant admission analyzed for association with induction agent and clinical factors. Participants were grouped by induction agent: interleukin-2 receptor blocker (IL2RB), anti-thymocyte globulin (ATG), and alemtuzumab. We also estimated inpatient care and other hospital-based services during the first year after transplantation.</p><p><strong>Results: </strong>A total of 831 children and young adults < 21 years who received a kidney transplant between January 2010 through 2019 were identified. Among these, 50.5% received ATG, 31.3% received IL2RB only, and 18.2% received alemtuzumab. Among clinical characteristics studied, sex and likelihood of pre-emptive transplant were similar among the groups. Though unadjusted index hospitalization costs (IHC) were significantly different among the induction groups, induction choice was not associated with IHC in multivariable analysis. Younger age at the time of transplantation and delayed graft function (DGF) were independently associated with higher IHC. Unadjusted hospital-based costs incurred after discharge from the transplant procedure through the first year after transplantation were similar among induction groups.</p><p><strong>Conclusion: </strong>Among pediatric and young adult kidney transplant recipients, IHC was comparable across induction agents. Younger age at transplantation and DGF were associated with significantly higher IHC.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70441"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13555108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912545","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}